Provider Demographics
NPI:1629815618
Name:PEREZ, JASMINE AYALA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:AYALA
Last Name:PEREZ
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 1:4784 SEQUOIA PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6125
Mailing Address - Country:US
Mailing Address - Phone:760-458-0985
Mailing Address - Fax:
Practice Address - Street 1:1261 E WASHINGTON AVE APT 206
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1952
Practice Address - Country:US
Practice Address - Phone:760-458-0985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1407734043OtherDRIVER LICENSE