Basic Information
| Provider Information | |||||||||
| NPI: | 1235872458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JAZIN | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25129 THE OLD RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | STEVENSON RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913812281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612841984 | ||||||||
| FaxNumber: | 6612894199 | ||||||||
| Practice Location | |||||||||
| Address1: | 25129 THE OLD RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | STEVENSON RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913812281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612841984 | ||||||||
| FaxNumber: | 6612841991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2022 | ||||||||
| LastUpdateDate: | 04/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT23261 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.