Individual
JORDAN BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4900 E CHAPMAN AVE UNIT 103, ORANGE, CA 92869-4140
(323) 365-6312
Mailing address
4900 E CHAPMAN AVE UNIT 103, ORANGE, CA 92869-4140
(323) 365-6312
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95014481
CA
Other
Enumeration date
01/14/2016
Last updated
05/06/2020
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