Provider Demographics
NPI:1326694480
Name:TRAMMELL, JASMINE (MA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:VANOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2615 CAMINO DEL RIO S STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3713
Mailing Address - Country:US
Mailing Address - Phone:951-326-4967
Mailing Address - Fax:
Practice Address - Street 1:2615 CAMINO DEL RIO S STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3713
Practice Address - Country:US
Practice Address - Phone:951-326-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health