MEDICARE: JASMINE DYJAK COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1508566191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASMINE DYJAK COUNSELING

Provider Business Mailing Address
First Line	:	2358 UNIVERSITY AVE # 2089
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2358 UNIVERSITY AVE # 2089
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2720
Country	:	US
Telephone Number	:	858-247-1399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE DYJAK
Credential	:
Telephone Number	:	858-247-1399

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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