Provider Demographics
NPI:1588184055
Name:JORDAN, MARIANELA (MD)
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIANELA
Other - Middle Name:
Other - Last Name:GOMEZ RINCON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MAIL STOP #2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2153
Mailing Address - Fax:323-953-8116
Practice Address - Street 1:3250 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1439
Practice Address - Country:US
Practice Address - Phone:323-361-2153
Practice Address - Fax:323-953-8116
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169505208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics