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NPI Code Detail

MEDICARE: JASMINE MALFAVON

MEDICARE: JASMINE MALFAVON
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
1104100000XSocial WorkerASW136732CA

General Provider Information

NPI Number : 1912751868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE MALFAVON
Provider Business Mailing Address
First Line : 323 N PRAIRIE AVE
Second Line :
City : INGLEWOOD
State : CA
Zip : 90301-4502
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2024
Last Update Date : 03/11/2026

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