Jordan, Jerry Wallace

Jordan, Jerry Wallace is an individual health care provider with primary practice located at 1212 N California St , Stockton CA 95202-1552. He recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as his primary health care specialty. Jordan, Jerry Wallace can be contacted via phone (209) 468-8831.

Contact Information

Primary practice address
1212 N California St Stockton CA 95202-1552
Phone: (209) 468-8831
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X

Profile Details

NPI number 1346414851
LBN Legal business name Jordan, Jerry Wallace
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 15th, 2008
Last updated Dec 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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