Provider Demographics
NPI:1558862714
Name:RIOS, JASMINE GARCIA (BA BCAT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:GARCIA
Last Name:RIOS
Suffix:
Gender:F
Credentials:BA BCAT
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:GARCIA
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2398 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-4464
Mailing Address - Country:US
Mailing Address - Phone:559-496-9855
Mailing Address - Fax:
Practice Address - Street 1:2398 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-4464
Practice Address - Country:US
Practice Address - Phone:559-496-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician