Healthcare Provider Details

I. General information

NPI: 1841636396
Provider Name (Legal Business Name): JASMINE BARDALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE STE 200
WHITTIER CA
90602-3168
US

IV. Provider business mailing address

7536 RACINE AVE
PARAMOUNT CA
90723-2123
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: