Healthcare Provider Details

I. General information

NPI: 1306551072
Provider Name (Legal Business Name): JASMIN VERENISE AMBRIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CALIFORNIA AVE
BAKERSFIELD CA
93309-0705
US

IV. Provider business mailing address

219 JEFFERSON ST
TAFT CA
93268-2011
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-1577
  • Fax:
Mailing address:
  • Phone: 661-623-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: