Provider Demographics
NPI:1992252860
Name:ELEK, JAZMIN KELLY (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JAZMIN
Middle Name:KELLY
Last Name:ELEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:ELEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:965 TERESITA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2324
Mailing Address - Country:US
Mailing Address - Phone:415-533-3043
Mailing Address - Fax:
Practice Address - Street 1:965 TERESITA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2324
Practice Address - Country:US
Practice Address - Phone:415-533-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5394174400000X
CA5394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist