Healthcare Provider Details

I. General information

NPI: 1477374502
Provider Name (Legal Business Name): JASMINE WHALEY RDH, RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43265 20TH ST W APT 33
LANCASTER CA
93534-5902
US

IV. Provider business mailing address

PO BOX 900094
PALMDALE CA
93590-0094
US

V. Phone/Fax

Practice location:
  • Phone: 424-375-0520
  • Fax:
Mailing address:
  • Phone: 424-375-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: