Provider Demographics
NPI:1821652306
Name:JORDAN, GLORISELIS (MRC)
Entity Type:Individual
Prefix:
First Name:GLORISELIS
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0248
Mailing Address - Country:US
Mailing Address - Phone:787-782-8250
Mailing Address - Fax:
Practice Address - Street 1:PR 2 KM 8.5
Practice Address - Street 2:BO JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-532-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR956225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR225C00000XOtherTHIS NUMBER WAS REQUIRED FOR MY JOB.