Healthcare Provider Details

I. General information

NPI: 1033056569
Provider Name (Legal Business Name): JASMIN PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15761 VIA ESMOND
SAN LORENZO CA
94580-1325
US

IV. Provider business mailing address

15761 VIA ESMOND
SAN LORENZO CA
94580-1325
US

V. Phone/Fax

Practice location:
  • Phone: 510-517-4161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: