1083623193 NPI number — DR. LUC JASMIN M.D.

Table of content: DR. LUC JASMIN M.D. (NPI 1083623193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083623193 NPI number — DR. LUC JASMIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JASMIN
Provider First Name:
LUC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083623193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5758 GEARY BLVD # 138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94121-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-414-9814
Provider Business Mailing Address Fax Number:
541-833-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 ROUTE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929-6911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-414-9814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  MTL-2023-017 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: C51196 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: M-2397 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R167651 . This is a "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 6865 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7685441 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA205563 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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