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NPI Code Detail

MEDICARE: JAZMYNE ELAINE FORTMAN

MEDICARE: JAZMYNE ELAINE FORTMAN
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
1106H00000XMarriage & Family Therapist155910CA

General Provider Information

NPI Number : 1134894686
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMYNE ELAINE FORTMAN
Provider Business Mailing Address
First Line : 8606 COMMONWEALTH AVE APT 156
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-5117
Country : US
Telephone Number : 714-472-7428
Fax Number :
Provider Business Practice Location Address
First Line : 238 S FLOWER ST
Second Line :
City : ORANGE
State : CA
Zip : 92868-3415
Country : US
Telephone Number : 714-472-7428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 01/12/2026

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Directions to “ JAZMYNE ELAINE FORTMAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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