Provider Demographics
NPI:1538945126
Name:XOCHIMITL, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:XOCHIMITL
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 1:9549 ANZAC AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2518
Mailing Address - Country:US
Mailing Address - Phone:323-404-0344
Mailing Address - Fax:
Practice Address - Street 1:14371 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-2901
Practice Address - Country:US
Practice Address - Phone:562-867-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program