Healthcare Provider Details

I. General information

NPI: 1538482567
Provider Name (Legal Business Name): IRINA JASPER MD A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 286
PASADENA CA
91106-2420
US

IV. Provider business mailing address

960 E GREEN ST STE 286
PASADENA CA
91106-2420
US

V. Phone/Fax

Practice location:
  • Phone: 626-356-0340
  • Fax: 626-356-0390
Mailing address:
  • Phone: 626-356-0340
  • Fax: 626-356-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA GALLEGOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-356-0340