Provider Demographics
NPI:1598199630
Name:ULIBARRI, JAZMINE ORTIZ (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JAZMINE
Middle Name:ORTIZ
Last Name:ULIBARRI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 433
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2057
Mailing Address - Country:US
Mailing Address - Phone:626-578-5501
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 433
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2057
Practice Address - Country:US
Practice Address - Phone:626-578-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116297106H00000X
CA78091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86-1569698OtherKAISER PERMANENTE