Healthcare Provider Details

I. General information

NPI: 1265231831
Provider Name (Legal Business Name): JASMINE S MCDONALD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 ROSENA AVE
LOMA LINDA CA
92354-1785
US

IV. Provider business mailing address

1740 ROSENA AVE
LOMA LINDA CA
92354-1785
US

V. Phone/Fax

Practice location:
  • Phone: 909-610-0759
  • Fax:
Mailing address:
  • Phone: 909-610-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: