Healthcare Provider Details

I. General information

NPI: 1316463748
Provider Name (Legal Business Name): JASMYNNE-SHAYE ROBBINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/07/2024
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 VENICE BLVD STE 751
LOS ANGELES CA
90019-5127
US

IV. Provider business mailing address

5630 VENICE BLVD STE 751
LOS ANGELES CA
90019-5127
US

V. Phone/Fax

Practice location:
  • Phone: 323-317-7272
  • Fax: 877-940-3126
Mailing address:
  • Phone: 323-317-7272
  • Fax: 877-940-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: