Healthcare Provider Details

I. General information

NPI: 1225535495
Provider Name (Legal Business Name): JASMINE LAVERNE MITCHELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD STE 600
SANTA MONICA CA
90404-2131
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5471
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA166266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: