Provider Demographics
NPI:1053299479
Name:GOUVEIA, JORDAN AUSTIN KAI (EMT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:AUSTIN KAI
Last Name:GOUVEIA
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:DARIEN
Other - Middle Name:JORDAN AUSTIN
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT
Mailing Address - Street 1:1500 PETALUMA BLVD S
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5545
Mailing Address - Country:US
Mailing Address - Phone:707-765-8488
Mailing Address - Fax:
Practice Address - Street 1:1500 PETALUMA BLVD S
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5545
Practice Address - Country:US
Practice Address - Phone:707-765-8488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE177413373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist