Provider Demographics
NPI:1235782053
Name:JOHNSON, JASMINE JAYE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:JAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 HOMECOMING DR UNIT 1545
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-8846
Mailing Address - Country:US
Mailing Address - Phone:951-675-9051
Mailing Address - Fax:
Practice Address - Street 1:16250 HOMECOMING DR UNIT 1545
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-8846
Practice Address - Country:US
Practice Address - Phone:951-675-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-21
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287195164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse