Provider Demographics
NPI:1043907736
Name:SMITH, JORDAN (ND)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 HALO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2718
Mailing Address - Country:US
Mailing Address - Phone:619-508-6035
Mailing Address - Fax:
Practice Address - Street 1:4545 FANUEL ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2904
Practice Address - Country:US
Practice Address - Phone:619-508-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1420175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath