Provider Demographics
NPI:1023891694
Name:ELKEBIR, JASMINE (RDHAP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ELKEBIR
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23535 PALOMINO DR STE 391
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1626
Mailing Address - Country:US
Mailing Address - Phone:949-339-3468
Mailing Address - Fax:
Practice Address - Street 1:5683 W OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2381
Practice Address - Country:US
Practice Address - Phone:949-339-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist