Healthcare Provider Details

I. General information

NPI: 1790931624
Provider Name (Legal Business Name): JASMIN ANN IGNATIUS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 STATE ST
BOSTON MA
02109-1827
US

IV. Provider business mailing address

75 STATE ST FL 26
BOSTON MA
02109-1827
US

V. Phone/Fax

Practice location:
  • Phone: 617-204-3500
  • Fax:
Mailing address:
  • Phone: 832-548-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN6374
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberCA20575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: