Provider Demographics
NPI:1073994901
Name:JENKINS, JASMINE RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 MARATHON ST APT 329
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2869
Mailing Address - Country:US
Mailing Address - Phone:818-450-6785
Mailing Address - Fax:
Practice Address - Street 1:3630 MARATHON ST APT 329
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2869
Practice Address - Country:US
Practice Address - Phone:818-450-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No283X00000XHospitalsRehabilitation Hospital