Healthcare Provider Details

I. General information

NPI: 1043943525
Provider Name (Legal Business Name): JASMINE PAUTHENA OKAFOR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 VANOWEN ST STE 207
CANOGA PARK CA
91303-2753
US

IV. Provider business mailing address

15030 VENTURA BLVD # 295
SHERMAN OAKS CA
91403-5470
US

V. Phone/Fax

Practice location:
  • Phone: 888-890-0043
  • Fax: 818-698-3900
Mailing address:
  • Phone: 888-890-0043
  • Fax: 818-698-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number80067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: