Active NPI
Jordan Samuel
- Student in an Organized Health Care Education/Training Program
- Colton, CA
National Provider Identifier
1366325649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 2291 Lalique Cir
Colton, CA 92324-9242 - Phone
- (901) 734-3464
- NPI assigned
- Jul 26, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
2291 Lalique Cir
Colton, CA 92324-9242
Mailing address
2291 Lalique Cir
Colton, CA 92324-9242
Phone (901) 734-3464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753488000000",
"number": "1366325649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2291 LALIQUE CIR",
"city": "COLTON",
"state": "CA",
"postal_code": "923249242",
"telephone_number": "901-734-3464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2291 LALIQUE CIR",
"city": "COLTON",
"state": "CA",
"postal_code": "923249242",
"telephone_number": "901-734-3464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "JORDAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-07-26",
"last_updated": "2025-07-26",
"certification_date": "2025-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.