Basic Information
| Provider Information | |||||||||
| NPI: | 1942553045 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEPULVEDA | ||||||||
| FirstName: | JAZMIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5849 CROCKER ST UNIT L | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Practice Location | |||||||||
| Address1: | 5849 CROCKER ST UNIT L | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900031311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232344445 | ||||||||
| FaxNumber: | 3232344477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2012 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 83012 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 92740 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.