Individual
JONATHAN JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 FRIEDMAN AVE, LAS VEGAS, NM 87701-4231
(505) 454-5100
Mailing address
3695 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-9549
(505) 454-5100
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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