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1245658210
JORDAN BLACK
SAN DIEGO, CA
NPI
1245658210
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: NY 134186154)
Enumeration Date
2014-04-07
Last Update Date
2015-06-22
Business Address
-- JORDAN BLACK M.D.
200 W ARBOR DR #8770
SAN DIEGO, CA 92103-9000
Phone number: 619-543-5297
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Mailing Address
-- JORDAN BLACK M.D.
1205 PACIFIC HWY UNIT 1304
SAN DIEGO, CA 92101-3327
Phone number: 315-317-6720
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