Doctor Name: | DR. JORDAN TAYLOR VULCANO |
NPI Number: | 1861734915 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | D01358731 |
Business Practice Address: | 1301 S. Crimson Road Mesa, AZ - 85204 |
Business Phone Number: | 4803732370 |
Business Fax Number: | 4803732375 |
Mailing Address: | 1301 S. Crimson Road, MESA |
State: | AZ |
Postal Code: | 85204 |
Phone Number: | 4803732370 |
Fax Number: | 4803732375 |
NPI Enumeration Date: | 03/26/2013 |
NPI Last Update Date: | 05/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | D01358731 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |