Provider Demographics
NPI:1518659788
Name:CARRANZA, JASMIN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:ELIZABETH
Last Name:CARRANZA
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 1:3333 CONCOURS STE 4102
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-6564
Mailing Address - Country:US
Mailing Address - Phone:909-240-2565
Mailing Address - Fax:
Practice Address - Street 1:12534 KIOWA RD APT 1
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-4239
Practice Address - Country:US
Practice Address - Phone:442-255-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician