Basic Information
| Provider Information | |||||||||
| NPI: | 1154604999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDHU | ||||||||
| FirstName: | JASPER (JESSIE) | ||||||||
| MiddleName: | |||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 BATTERY ST APT 1415 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941112328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609619826 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 POTRERO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152065270 | ||||||||
| FaxNumber: | 4152064722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2011 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N/A | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.