Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | RBT-18-68453 | CA |
NPI | 1316413123 |
---|---|
Provider Name | Jasmine Beverly |
First Address | Sun City, CA 92586-2509 |
Second Address | Sun City, CA 92586-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 18/10/2018 |