Healthcare Provider Details

I. General information

NPI: 1942114269
Provider Name (Legal Business Name): JASMINE RAE PAUW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE RAE SELANDERS

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 N HARBOR BLVD STE 120
FULLERTON CA
92832-1323
US

IV. Provider business mailing address

10392 PUA DR
HUNTINGTON BEACH CA
92646-2558
US

V. Phone/Fax

Practice location:
  • Phone: 714-472-0777
  • Fax:
Mailing address:
  • Phone: 714-472-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95305429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: