1932583150 NPI number — JAZMYNE ARTEESE BOSLEY NP

Table of content: (NPI 1801980941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932583150 NPI number — JAZMYNE ARTEESE BOSLEY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSLEY
Provider First Name:
JAZMYNE
Provider Middle Name:
ARTEESE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREENE
Provider Other First Name:
JAZMYNE
Provider Other Middle Name:
ARTEESE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932583150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 S MELROSE DR STE 123
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-6641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-668-3635
Provider Business Mailing Address Fax Number:
515-854-8206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 S MELROSE DR STE 123
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-6641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-668-3635
Provider Business Practice Location Address Fax Number:
515-854-8206
Provider Enumeration Date:
07/17/2015

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: 163WP0808X , with the licence number:  851785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X , with the licence number: 851785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP139156 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 95010166 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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