Healthcare Provider Details

I. General information

NPI: 1346402591
Provider Name (Legal Business Name): JASON W LEE BA SOCIOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 GRAND CYPRESS AVE
PALMDALE CA
93551-3675
US

IV. Provider business mailing address

250 GRAND CYPRESS AVE
PALMDALE CA
93551-3675
US

V. Phone/Fax

Practice location:
  • Phone: 661-789-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: