Healthcare Provider Details

I. General information

NPI: 1487349031
Provider Name (Legal Business Name): JASMINE ASHLEY DWYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 SOUTH HIGHLAND SPRINGS AVENUE SUITE 301
BEAUMONT CA
92223
US

IV. Provider business mailing address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 951-846-2624
  • Fax: 951-846-2621
Mailing address:
  • Phone: 910-678-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA208615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: