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NPI Code Detail

MEDICARE: SORA LEE M.A. BCBA

MEDICARE: SORA LEE M.A. BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-13-14676CA
2103K00000XBehavior Analyst4659TX
3103K00000XBehavior Analyst0135331CA

General Provider Information

NPI Number : 1336489566
Entity Type Code : Individual
Provider Name (Legal Business Name) : SORA LEE M.A. BCBA
Provider Business Mailing Address
First Line : 211 GRAND AVE APT 204
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-6136
Country : US
Telephone Number : 650-291-5523
Fax Number :
Provider Business Practice Location Address
First Line : 7090 MIRATECH DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3109
Country : US
Telephone Number : 858-304-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2013
Last Update Date : 11/24/2025

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