MEDICARE: JASMINE NICOLE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1093679870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE NICOLE WILLIAMS

Provider Business Mailing Address
First Line	:	19348 HARTLAND ST
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3757
Country	:	US
Telephone Number	:	818-419-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	25115 AVENUE STANFORD
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	800-772-1213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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