Provider Demographics
NPI:1043954605
Name:TAYLOR, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 SANTA FE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-2922
Mailing Address - Country:US
Mailing Address - Phone:510-316-4968
Mailing Address - Fax:
Practice Address - Street 1:2939 SANTA FE AVE APT 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810-2922
Practice Address - Country:US
Practice Address - Phone:510-316-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician