Healthcare Provider Details

I. General information

NPI: 1700333622
Provider Name (Legal Business Name): JASMINE GUMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 LENZEN AVE STE 1800
SAN JOSE CA
95126-2737
US

IV. Provider business mailing address

976 LENZEN AVE STE 1800
SAN JOSE CA
95126-2737
US

V. Phone/Fax

Practice location:
  • Phone: 408-792-5939
  • Fax: 408-792-5031
Mailing address:
  • Phone: 408-792-5939
  • Fax: 408-792-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: