Healthcare Provider Details

I. General information

NPI: 1184280570
Provider Name (Legal Business Name): JAZMIN A WHITE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 CLAREMONT AVE
OAKLAND CA
94618-1032
US

IV. Provider business mailing address

201 COGGINS DR APT B109
PLEASANT HILL CA
94523-4567
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 707-805-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: