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General NPI Number Information
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NPI Number | 1649776980
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Entity Type | Individual
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Provider Name | JASMINE AVILEZ MA
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 9265 SKY PARK CT STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92123-4375
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Country | US
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Telephone | 844-737-3638
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Fax | 619-403-9496
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Provider Business Mailing Address
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Address Line | 1542 S GRENOBLE AVE
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City | WEST COVINA
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State | CA
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Zip | 91791-4040
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Country | US
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Telephone | 626-201-7089
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 105085
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT144412
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License Number State | CA
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