Provider Demographics
NPI:1821697673
Name:LEOS, JAZMIN LEE
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:LEE
Last Name:LEOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 KLAMATH LN STE 20
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-8979
Mailing Address - Country:US
Mailing Address - Phone:916-729-3098
Mailing Address - Fax:
Practice Address - Street 1:210 10TH STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987
Practice Address - Country:US
Practice Address - Phone:530-531-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician