Provider Demographics
NPI:1629824354
Name:JSP CORPORATION INC
Entity type:Organization
Organization Name:JSP CORPORATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:442-224-3320
Mailing Address - Street 1:36330 HIDDEN SPRINGS RD STE E
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-5804
Mailing Address - Country:US
Mailing Address - Phone:442-224-3320
Mailing Address - Fax:855-413-4147
Practice Address - Street 1:36330 HIDDEN SPRINGS RD STE E
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-5804
Practice Address - Country:US
Practice Address - Phone:442-224-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty