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General NPI Number Information
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NPI Number | 1679373781
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Entity Type | Individual
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Provider Name | JAZMIN CARRILLO SUDRC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1580 CHABOT CT
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City | HAYWARD
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State | CA
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Zip | 94545-2423
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Country | US
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Telephone | 510-783-8708
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Fax |
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Provider Business Mailing Address
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Address Line | 25928 ELDRIDGE AVE
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City | HAYWARD
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State | CA
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Zip | 94544-2650
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Country | US
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Telephone | 510-342-6858
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20960
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License Number State | CA
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