Healthcare Provider Details

I. General information

NPI: 1316719719
Provider Name (Legal Business Name): JAZMIN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST
BARSTOW CA
92311-2361
US

IV. Provider business mailing address

222 E MAIN ST
BARSTOW CA
92311-2361
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1496
  • Fax:
Mailing address:
  • Phone: 760-255-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: