Provider Demographics
NPI:1174923502
Name:JORDAN, PATRICIO (CEO)
Entity type:Individual
Prefix:
First Name:PATRICIO
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE ADVANCED 5 CALLE RICARDO ARIAS
Mailing Address - Street 2:AREA BANCARIA
Mailing Address - City:PANAMA
Mailing Address - State:PANAMA
Mailing Address - Zip Code:08230-1930
Mailing Address - Country:PA
Mailing Address - Phone:507-396-0586
Mailing Address - Fax:507-396-0587
Practice Address - Street 1:TORRE ADVANCED 5 CALLE RICARDO ARIAS
Practice Address - Street 2:AREA BANCARIA
Practice Address - City:PANAMA
Practice Address - State:PANAMA
Practice Address - Zip Code:08230-1930
Practice Address - Country:PA
Practice Address - Phone:507-396-0586
Practice Address - Fax:507-396-0587
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
171W0000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor