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NPI Code Detail

MEDICARE: JACOB LEE

MEDICARE: JACOB LEE
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 AnalystLBA0682NV

General Provider Information

NPI Number : 1720556194
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB LEE
Provider Business Mailing Address
First Line : 5575 S DURANGO DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-1834
Country : US
Telephone Number : 702-209-3544
Fax Number : 725-205-3800
Provider Business Practice Location Address
First Line : 555 N MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-3133
Country : US
Telephone Number : 702-265-8436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2018
Last Update Date : 01/11/2023

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