Provider Demographics
NPI:1326025941
Name:MCLEOD, JASMINE JOY (MD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:JOY
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29798 HAUN RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6541
Mailing Address - Country:US
Mailing Address - Phone:909-886-6904
Mailing Address - Fax:909-881-6424
Practice Address - Street 1:339 E HIGHLAND AVE
Practice Address - Street 2:SUITE 524
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3878
Practice Address - Country:US
Practice Address - Phone:909-886-6904
Practice Address - Fax:909-881-6424
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN804XMedicare PIN
CABN804ZMedicare PIN
CAE77254Medicare UPIN