Provider Demographics
NPI:1881273431
Name:JORDA, DARRYL
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:JORDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22022 FIESEL AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3517
Mailing Address - Country:US
Mailing Address - Phone:310-308-2299
Mailing Address - Fax:
Practice Address - Street 1:22022 FIESEL AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3517
Practice Address - Country:US
Practice Address - Phone:310-308-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist