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1710540034
JORDAN PAUL
CORONA, CA
NPI
1710540034
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA R1333970119)
Enumeration Date
2019-04-22
Last Update Date
2019-04-22
Business Address
JORDAN PAUL RADT
623 N MAIN ST
CORONA, CA 92880-1407
Phone number: 909-488-9477
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Mailing Address
JORDAN PAUL RADT
623 N MAIN ST
CORONA, CA 92880-1407
Phone number:
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