MEDICARE: IRINA JASPER MD A PROFESSIONAL CORP

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	261QP2300X	Primary Care Clinic/Center
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1356421903	OTHER	CA	NPI

General Provider Information

NPI Number	:	1538482567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRINA JASPER MD A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	960 E GREEN ST STE 286
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2420
Country	:	US
Telephone Number	:	626-356-0340
Fax Number	:	626-356-0390

Provider Business Practice Location Address
First Line	:	960 E GREEN ST STE 286
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2420
Country	:	US
Telephone Number	:	626-356-0340
Fax Number	:	626-356-0390

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PATRICIA GALLEGOS
Credential	:
Telephone Number	:	626-356-0340

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	01/25/2018

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