Provider Demographics
NPI:1669139044
Name:DANESHZADEH, JORDAN POURAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:POURAN
Last Name:DANESHZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40028 BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5264
Mailing Address - Country:US
Mailing Address - Phone:661-480-8293
Mailing Address - Fax:
Practice Address - Street 1:25733 RYE CANYON RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1135
Practice Address - Country:US
Practice Address - Phone:661-295-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant