Healthcare Provider Details

I. General information

NPI: 1629405725
Provider Name (Legal Business Name): GINILLE JASMIN LAZARO BROWN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 GARFIELD AVE
BELL GARDENS CA
90201-1805
US

IV. Provider business mailing address

1706 CAMINO DE LA COSTA APT A
REDONDO BEACH CA
90277-5408
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-9600
  • Fax:
Mailing address:
  • Phone: 916-690-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: