Provider Demographics
NPI:1417467648
Name:ANGUIANO, JASMINE ALYSE (ATC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALYSE
Last Name:ANGUIANO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LAVANDA DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2509
Mailing Address - Country:US
Mailing Address - Phone:805-889-2028
Mailing Address - Fax:
Practice Address - Street 1:545 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-1045
Practice Address - Country:US
Practice Address - Phone:805-278-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000228262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer