Healthcare Provider Details

I. General information

NPI: 1326958778
Provider Name (Legal Business Name): JASMINE LARA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40292 LESLIE ST
FREMONT CA
94538-3520
US

IV. Provider business mailing address

40292 LESLIE ST
FREMONT CA
94538-3520
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230158583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: