Healthcare Provider Details

I. General information

NPI: 1013428713
Provider Name (Legal Business Name): LAURA MARIE JASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CAPITOL AVE
SACRAMENTO CA
95816-5721
US

IV. Provider business mailing address

2100 CAPITOL AVE
SACRAMENTO CA
95816-5721
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-4985
  • Fax: 916-442-1029
Mailing address:
  • Phone: 916-442-4985
  • Fax: 916-442-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12950
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-URMXIW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: