Provider Demographics
NPI:1780120576
Name:TABANKIA, JASMINE (LAC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TABANKIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5944 DONNA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1219
Mailing Address - Country:US
Mailing Address - Phone:818-825-2248
Mailing Address - Fax:
Practice Address - Street 1:5944 DONNA AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1219
Practice Address - Country:US
Practice Address - Phone:818-825-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist