Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jasmine Sourivong

Individual provider Specialist · NPI 1215655311

Jasmine Sourivong is a Specialist in Stockton, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2022
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Practice location Address checks out

2185 W Rose St
Stockton, CA 95203-1208
Phone: (510) 593-1835
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X (CA)

Record details

NPI number1215655311
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 16, 2022
Last updated in NPPESAugust 16, 2022
Certification dateAugust 16, 2022

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