Provider Demographics
NPI:1184350951
Name:CASUPANAN, JASMINE (LAC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CASUPANAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18307 LAPIS LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-8963
Mailing Address - Country:US
Mailing Address - Phone:909-997-5330
Mailing Address - Fax:
Practice Address - Street 1:9125 ARCHIBALD AVE STE B
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5228
Practice Address - Country:US
Practice Address - Phone:909-808-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19140171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist