Basic Information
| Provider Information | |||||||||
| NPI: | 1487989844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | DANETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1241 E. DYER RD, | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494491112 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8815 GERMANTOWN AVE | ||||||||
| Address2: | 5TH FLOOR FAMILY PRACTICE | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191182722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152488145 | ||||||||
| FaxNumber: | 2152488852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2009 | ||||||||
| LastUpdateDate: | 05/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT195141 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2013-02418 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53726 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD446787 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.