Individual
LISA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 N PILGRIM ST, STOCKTON, CA 95205-4428
(209) 466-0853
Mailing address
430 N PILGRIM ST, STOCKTON, CA 95205-4428
(209) 466-0853
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
0
CA
Other
Enumeration date
10/30/2018
Last updated
10/30/2018
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