Provider Demographics
NPI:1659401412
Name:ALDRICH, JASMINE TURRUBIATE (PA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:TURRUBIATE
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:TURRUBIATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8383 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3007
Mailing Address - Country:US
Mailing Address - Phone:303-338-4545
Mailing Address - Fax:
Practice Address - Street 1:8383 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3007
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61534731Medicaid
015970OtherKAISER-COMMERCIAL NUMBER
COQ38000Medicare UPIN
015970OtherKAISER-COMMERCIAL NUMBER
COCOA103838Medicare PIN