Provider Demographics
NPI:1164396404
Name:GINEZ VASQUEZ, JASMINE ELIZABETH
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ELIZABETH
Last Name:GINEZ VASQUEZ
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 1:2801 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1361
Mailing Address - Country:US
Mailing Address - Phone:415-374-3957
Mailing Address - Fax:
Practice Address - Street 1:165 22ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3203
Practice Address - Country:US
Practice Address - Phone:408-835-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator