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General NPI Number Information
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NPI Number | 1417425570
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Entity Type | Individual
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Provider Name | STEPHANIE LEE-SOUZA
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 341 CORPORATE TERRACE CIR # 10
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City | CORONA
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State | CA
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Zip | 92879-6028
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Country | US
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Telephone | 714-582-5930
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Fax |
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Provider Business Mailing Address
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Address Line | 7955 MAGNOLIA AVE APT 27D
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City | RIVERSIDE
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State | CA
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Zip | 92504-6402
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Country | US
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Telephone | 909-697-0630
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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 | 103K00000X
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License Number State | CA
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