Provider Demographics
NPI:1104270925
Name:DWORKIN, JORDANNA EVE (LAC)
Entity type:Individual
Prefix:
First Name:JORDANNA
Middle Name:EVE
Last Name:DWORKIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GUERRERO ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1645
Mailing Address - Country:US
Mailing Address - Phone:646-234-4840
Mailing Address - Fax:
Practice Address - Street 1:750 GUERRERO ST APT 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1645
Practice Address - Country:US
Practice Address - Phone:646-234-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13357171100000X
NY002834171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist