Healthcare Provider Details

I. General information

NPI: 1265011001
Provider Name (Legal Business Name): JPL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14860 ROSCOE BLVD STE 304
PANORAMA CITY CA
91402-4695
US

IV. Provider business mailing address

14860 ROSCOE BLVD STE 304
PANORAMA CITY CA
91402-4695
US

V. Phone/Fax

Practice location:
  • Phone: 949-246-9750
  • Fax: 906-254-3118
Mailing address:
  • Phone: 949-246-9750
  • Fax: 906-254-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON P LEE
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 747-999-5313