Basic Information
| Provider Information | |||||||||
| NPI: | 1841716842 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARNICA | ||||||||
| FirstName: | JASMINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13008 JUDITH ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917065839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266328264 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1520 N RAYMOND AVE BLDG 2-7 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911031819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263965920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2017 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.