Provider Demographics
NPI:1891483640
Name:WONG, JASMINE I (BCBA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WONG
Suffix:I
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2060 W LANCASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6511
Mailing Address - Country:US
Mailing Address - Phone:661-227-5222
Mailing Address - Fax:
Practice Address - Street 1:626 W LANCASTER BLVD # 52
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3108
Practice Address - Country:US
Practice Address - Phone:661-258-3211
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician