Provider Demographics
NPI:1376140665
Name:HADDAD, JASMINE (ND)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 PALM ST APT C
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3198
Mailing Address - Country:US
Mailing Address - Phone:480-275-0652
Mailing Address - Fax:
Practice Address - Street 1:1415 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2915
Practice Address - Country:US
Practice Address - Phone:805-543-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1192175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath