Provider Demographics
NPI:1982335915
Name:KHADER, YASMINE CHRISTINE
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:CHRISTINE
Last Name:KHADER
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 1:1180 N INDIAN CANYON DR STE E140
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4883
Mailing Address - Country:US
Mailing Address - Phone:760-323-1001
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR STE E140
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4883
Practice Address - Country:US
Practice Address - Phone:760-323-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43642390200000X
CAINT43642390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program