Organization
FIESTA HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN P BOUDREAU PHD (OWNER/CHIEF CLINICAL OFFICER)
(231) 497-0555
Entity
Organization
Contact information
Practice address
800 E 70TH ST, SAVANNAH, GA 31405-4813
(912) 214-3314
(912) 722-4061
Mailing address
634 HOLGATE AVE, DEFIANCE, OH 43512-2038
(912) 491-2491
(470) 329-0008
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/10/2022
Last updated
09/20/2024
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