Healthcare Provider Details

I. General information

NPI: 1417590886
Provider Name (Legal Business Name): JASMINE L HENDRIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 S VERMONT AVE
LOS ANGELES CA
90044-3493
US

IV. Provider business mailing address

PO BOX 662165
LOS ANGELES CA
90066-8565
US

V. Phone/Fax

Practice location:
  • Phone: 323-525-6413
  • Fax:
Mailing address:
  • Phone: 310-993-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32820
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number32820
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: