Healthcare Provider Details

I. General information

NPI: 1710765896
Provider Name (Legal Business Name): JASMINE MANITI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 4TH ST STE D1
SAN RAFAEL CA
94901-3246
US

IV. Provider business mailing address

874 4TH ST STE D1
SAN RAFAEL CA
94901-3246
US

V. Phone/Fax

Practice location:
  • Phone: 415-968-6515
  • Fax:
Mailing address:
  • Phone: 415-968-6515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: