Provider Demographics
NPI:1083623193
Name:JASMIN, LUC (MD)
Entity Type:Individual
Prefix:DR
First Name:LUC
Middle Name:
Last Name:JASMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 GEARY BLVD # 138
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2112
Mailing Address - Country:US
Mailing Address - Phone:541-414-9814
Mailing Address - Fax:541-833-5006
Practice Address - Street 1:133 ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6911
Practice Address - Country:US
Practice Address - Phone:541-414-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMTL-2023-017207T00000X
CAC51196207T00000X
GUM-2397207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR167651OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
OR6865Medicaid
CA7685441Medicaid
CACA205563OtherMEDICARE PTAN
TXF74334Medicare UPIN
ORR167651OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
CA00C511960Medicare PIN