Provider Demographics
NPI:1174375257
Name:BERGADO, JASMIN NICOLE JAYLO (PMHNP)
Entity type:Individual
Prefix:
First Name:JASMIN NICOLE
Middle Name:JAYLO
Last Name:BERGADO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 ONTARIO DR APT 24
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5480
Mailing Address - Country:US
Mailing Address - Phone:669-231-9091
Mailing Address - Fax:
Practice Address - Street 1:808 W SAN CARLOS ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4331
Practice Address - Country:US
Practice Address - Phone:669-231-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026428363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health