Healthcare Provider Details

I. General information

NPI: 1336720184
Provider Name (Legal Business Name): JASMINE ALEJANDRINA CORREA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-3518
US

IV. Provider business mailing address

6349 SHOW HORSE WAY
RANCHO CUCAMONGA CA
91739-9101
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-4568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: