Provider Demographics
NPI:1124242136
Name:JAFFE, JASMINE YUZANA (NP)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:YUZANA
Last Name:JAFFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SHERMAN DR STE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4001
Mailing Address - Country:US
Mailing Address - Phone:951-343-1700
Mailing Address - Fax:951-343-1777
Practice Address - Street 1:3838 SHERMAN DR
Practice Address - Street 2:SUITE #5
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4001
Practice Address - Country:US
Practice Address - Phone:951-343-1700
Practice Address - Fax:951-343-1777
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14924OtherNP
CA588640OtherRN