Provider Demographics
NPI:1689133738
Name:EALA, JORDAN (AA, BA IN PROGRESS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:EALA
Suffix:
Gender:M
Credentials:AA, BA IN PROGRESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 S THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9763
Mailing Address - Country:US
Mailing Address - Phone:559-853-8241
Mailing Address - Fax:
Practice Address - Street 1:546 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-3629
Practice Address - Country:US
Practice Address - Phone:559-623-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator