Provider Demographics
NPI:1487451407
Name:LAOLAGI, JASON
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:LAOLAGI
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 1:2522 CHAMBERS RD STE 219
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6962
Mailing Address - Country:US
Mailing Address - Phone:714-552-4725
Mailing Address - Fax:949-264-9490
Practice Address - Street 1:2522 CHAMBERS RD STE 219
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6962
Practice Address - Country:US
Practice Address - Phone:714-552-4725
Practice Address - Fax:949-264-9490
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5349696106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician