MEDICARE: JASMINE HERNDON

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	95397042	CA

General Provider Information

NPI Number	:	1740139476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE HERNDON

Provider Business Mailing Address
First Line	:	2727 CAMINO DEL RIO S STE 123
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3739
Country	:	US
Telephone Number	:	619-894-7376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 CAMINO DEL RIO S STE 123
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3739
Country	:	US
Telephone Number	:	619-894-7376
Fax Number	:	619-810-2291

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ JASMINE HERNDON ” Practice Location

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