Provider Demographics
NPI:1407919350
Name:PATEL, JASMINE (MSAOM, LAC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MSAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 SW SHADY LN
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5481
Mailing Address - Country:US
Mailing Address - Phone:503-573-4239
Mailing Address - Fax:503-573-4241
Practice Address - Street 1:9735 SW SHADY LN
Practice Address - Street 2:SUITE 306
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5481
Practice Address - Country:US
Practice Address - Phone:503-573-4239
Practice Address - Fax:503-573-4241
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0965171100000X
WA00002104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00002104OtherACUPUNCTURE LICENSE NUMBE
OR0965OtherACUPUNCTURE LICENSE NUMBE