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NPI Code Detail

MEDICARE: JASMINE MARIAN KENNEDY

MEDICARE: JASMINE MARIAN KENNEDY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1366304313
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE MARIAN KENNEDY
Provider Business Mailing Address
First Line : 120 ENGLEMANN DR
Second Line :
City : CORONA
State : CA
Zip : 92881-8472
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6876 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-2860
Country : US
Telephone Number : 800-207-0272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2025
Last Update Date : 12/07/2025

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Directions to “ JASMINE MARIAN KENNEDY ” Practice Location

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