Individual
JORDAN TAKEO LILIENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 459-3770
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A124428
CA
2086S0102X
Surgical Critical Care Physician
Primary
A124428
CA
2086S0127X
Trauma Surgery Physician
A124428
CA
Other
Enumeration date
09/08/2009
Last updated
01/15/2020
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