NPI 1265909055

Lisa Jordan

Practitioner Prevention Professional Stockton, CA

Practice location

Address: 430 N Pilgrim St, Stockton, CA 95205-4428
Phone: (209) 466-0853

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 0 (CA)

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Registry record

NPI: 1265909055
Entity type: Individual
Sex (as registered): Female
NPI issued: 30 Oct 2018
Record last updated: 30 Oct 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.