Jordan Elizabeth Moultrie
Individual provider Active NPI Behavior Technician · Gardenia, CA
NPI 1104675719 · NPPES record last updated May 15, 2024
Key facts
- NPI
- 1104675719
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 1508 W. Artesia Square
Suite B
Gardenia, CA 90248 - Phone
- (800) 249-1266
- NPI assigned
- May 15, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
1508 W. Artesia Square
Suite B
Gardenia, CA 90248
Mailing address
1301 E Orangewood Ave
Anaheim, CA 92805-6807
Other providers in Gardenia, CA
All providers in Gardenia, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.