Provider Demographics
NPI:1942330550
Name:BERKE, JASMINE DEBRA (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DEBRA
Last Name:BERKE
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CAPITOLA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2759
Mailing Address - Country:US
Mailing Address - Phone:831-479-1036
Mailing Address - Fax:
Practice Address - Street 1:2425 PORTER STREET
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-479-1036
Practice Address - Fax:831-401-2604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist