Basic Information
| Provider Information | |||||||||
| NPI: | 1073114302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JASSO | ||||||||
| FirstName: | GUADALUPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4063 WHITTIER BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900232536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232682100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4063 WHITTIER BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900232536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232682100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.