Provider Demographics
NPI:1114560711
Name:MAYFIELD, JAZMINE RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:RAE
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 ARMOURDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4415
Mailing Address - Country:US
Mailing Address - Phone:562-234-6143
Mailing Address - Fax:
Practice Address - Street 1:341 MAGNOLIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3332
Practice Address - Country:US
Practice Address - Phone:951-735-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant