Provider Demographics
NPI:1194574327
Name:VERDUZCO, JAZMINE MONIQUE
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:MONIQUE
Last Name:VERDUZCO
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 1:4519 NEWHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3641
Mailing Address - Country:US
Mailing Address - Phone:510-372-6137
Mailing Address - Fax:
Practice Address - Street 1:1255 ALLSTON WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1833
Practice Address - Country:US
Practice Address - Phone:510-845-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program