Healthcare Provider Details

I. General information

NPI: 1659564276
Provider Name (Legal Business Name): TINA B. JASPAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 EUGENIA PL SUITE B
CARPINTERIA CA
93013-1997
US

IV. Provider business mailing address

1135 EUGENIA PL SUITE B
CARPINTERIA CA
93013-1997
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-9194
  • Fax: 805-566-9256
Mailing address:
  • Phone: 805-566-9194
  • Fax: 805-566-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number47782
License Number StateCA

VIII. Authorized Official

Name: TINA B JASPAN
Title or Position: OWNER
Credential:
Phone: 805-566-9194