MEDICARE: JAZMIN BRISENO

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
2	101YM0800X	Mental Health Counselor	LCSW97960	CA
3	1041C0700X	Clinical Social Worker	LCSW97960	CA

General Provider Information

NPI Number	:	1831433184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMIN BRISENO

Provider Business Mailing Address
First Line	:	6001 E WASHINGTON BLVD
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-2451
Country	:	US
Telephone Number	:	562-928-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 E WASHINGTON BLVD
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-2451
Country	:	US
Telephone Number	:	562-928-9600
Fax Number	:

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	02/26/2024

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