Provider Demographics
NPI:1982799771
Name:MOINI, JASMINE (MD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:MOINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OLD RIVER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9506
Mailing Address - Country:US
Mailing Address - Phone:661-665-0184
Mailing Address - Fax:661-665-8219
Practice Address - Street 1:300 OLD RIVER RD STE 110
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9506
Practice Address - Country:US
Practice Address - Phone:661-665-0184
Practice Address - Fax:661-665-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G540490Medicare PIN