Provider Demographics
NPI:1477124485
Name:GARCIA, JASMYN
Entity Type:Individual
Prefix:
First Name:JASMYN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 S MARYLAND PKWY APT 2024
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6389
Mailing Address - Country:US
Mailing Address - Phone:702-496-1727
Mailing Address - Fax:
Practice Address - Street 1:6771 W CHARLESTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9016
Practice Address - Country:US
Practice Address - Phone:702-405-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician