Provider Demographics
NPI:1740949312
Name:GARCIA, JASMINE ALICIA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALICIA
Last Name:GARCIA
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 1:3142 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1368
Mailing Address - Country:US
Mailing Address - Phone:209-383-9086
Mailing Address - Fax:209-383-0624
Practice Address - Street 1:3142 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1368
Practice Address - Country:US
Practice Address - Phone:209-383-9086
Practice Address - Fax:209-383-0624
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146545183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician