Provider Demographics
NPI:1538690995
Name:VASSAR, CODIE JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:CODIE
Middle Name:JORDAN
Last Name:VASSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 W CHAPMAN AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2316
Mailing Address - Country:US
Mailing Address - Phone:714-712-0711
Mailing Address - Fax:
Practice Address - Street 1:2230 W CHAPMAN AVE STE 212
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2316
Practice Address - Country:US
Practice Address - Phone:714-712-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361591952084P0800X
WI69783202084P0800X, 208D00000X
IN01088491A2084P0800X
FLME1659832084P0800X
TXT89672084P0800X
WIT89672084P0800X
CAA1826712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice