Provider Demographics
NPI:1811874746
Name:KAZMIERCZAK, JASMIN ITZEL
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:ITZEL
Last Name:KAZMIERCZAK
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 1:1700 E SAINT ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4933
Mailing Address - Country:US
Mailing Address - Phone:714-667-9761
Mailing Address - Fax:
Practice Address - Street 1:1700 E SAINT ANDREW PL
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4933
Practice Address - Country:US
Practice Address - Phone:714-667-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker