Provider Demographics
NPI:1235467705
Name:TEJEDA, JASMINE MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:MARIE
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3902
Mailing Address - Country:US
Mailing Address - Phone:253-255-5364
Mailing Address - Fax:
Practice Address - Street 1:2605 JAHN AVE NW
Practice Address - Street 2:SUITE D-4
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8902
Practice Address - Country:US
Practice Address - Phone:253-255-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60101558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60101558OtherWA STATE DEPT HEALTH LMP LICENSE