Healthcare Provider Details

I. General information

NPI: 1528947199
Provider Name (Legal Business Name): JAZMINE PANTOJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 I ST STE. 200, 2ND FLOOR
MODESTO CA
95354-1110
US

IV. Provider business mailing address

1601 I ST STE 200
MODESTO CA
95354-1135
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6225
  • Fax: 209-558-4326
Mailing address:
  • Phone: 209-525-6225
  • Fax: 209-558-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: