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General NPI Number Information
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NPI Number | 1386526580
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Entity Type | Individual
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Provider Name | RYAN LEE
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Gender | Male
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 751 CAMINO PLZ # A
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City | SAN BRUNO
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State | CA
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Zip | 94066-3401
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Country | US
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Telephone | 165-062-7804
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Fax |
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Provider Business Mailing Address
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Address Line | 241 SAN MARCO AVE
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City | SAN BRUNO
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State | CA
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Zip | 94066-5530
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Country | US
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Telephone | 650-339-8967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB1389337
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License Number State | CA
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