Provider Demographics
NPI:1437540192
Name:MA, JASMINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7635 LEESBURG PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2520
Mailing Address - Country:US
Mailing Address - Phone:703-867-8921
Mailing Address - Fax:703-893-8809
Practice Address - Street 1:7635 LEESBURG PIKE STE A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2520
Practice Address - Country:US
Practice Address - Phone:703-867-8921
Practice Address - Fax:703-893-8809
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000651171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist