Provider Demographics
NPI:1912719980
Name:BRIDGER, JORDAN (PHD)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:BRIDGER
Suffix:
Gender:X
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CAMPER VIEW RD # SITED3
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3924
Mailing Address - Country:US
Mailing Address - Phone:951-438-5175
Mailing Address - Fax:
Practice Address - Street 1:1440 CAMPER VIEW RD # SITED3
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3924
Practice Address - Country:US
Practice Address - Phone:951-438-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor