Healthcare Provider Details

I. General information

NPI: 1073428793
Provider Name (Legal Business Name): JASMINE OKEREKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 ROSECRANS AVE STE 300
MANHATTAN BEACH CA
90266-2494
US

IV. Provider business mailing address

870 W BONITA AVE APT 211
CLAREMONT CA
91711-4176
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-8769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94029734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: