Healthcare Provider Details

I. General information

NPI: 1174410161
Provider Name (Legal Business Name): JASMIN P PARRA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GREEN VALLEY RD
FREEDOM CA
95019-3135
US

IV. Provider business mailing address

PO BOX 1652
WATSONVILLE CA
95077-1652
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone: 831-840-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number35987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: