Provider Demographics
NPI:1265771653
Name:LARSON, JASMIN VALDEZ
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:VALDEZ
Last Name:LARSON
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 1:3512 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5955
Mailing Address - Country:US
Mailing Address - Phone:925-338-4446
Mailing Address - Fax:925-238-0827
Practice Address - Street 1:3512 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-5955
Practice Address - Country:US
Practice Address - Phone:925-338-4446
Practice Address - Fax:925-238-0827
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3006478343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)