Provider Demographics
NPI:1083454763
Name:LAU, JONATHAN TADAO
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TADAO
Last Name:LAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 ARNOLD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7726
Mailing Address - Country:US
Mailing Address - Phone:925-587-1456
Mailing Address - Fax:
Practice Address - Street 1:5601 ARNOLD RD STE 108
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7726
Practice Address - Country:US
Practice Address - Phone:925-587-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician