Provider Demographics
NPI:1467899658
Name:SULLIVAN, JASMIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25660 RIVER BEND DR APT G
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-6272
Mailing Address - Country:US
Mailing Address - Phone:917-696-6874
Mailing Address - Fax:917-696-6874
Practice Address - Street 1:16756 CHINO CORONA ROAD
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708
Practice Address - Country:US
Practice Address - Phone:909-597-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty