Provider Demographics
NPI:1669139044
Name:DANESHZADEH, JORDAN POURAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:POURAN
Last Name:DANESHZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 SEVEN HILLS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4378
Mailing Address - Country:US
Mailing Address - Phone:725-777-0414
Mailing Address - Fax:702-565-5027
Practice Address - Street 1:870 SEVEN HILLS DR STE 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4378
Practice Address - Country:US
Practice Address - Phone:725-777-0414
Practice Address - Fax:702-565-5027
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA3197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant