MEDICARE: HALEY & LEE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C25282	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C25282	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1396922647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALEY & LEE INC

Provider Business Mailing Address
First Line	:	4361 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-1651
Country	:	US
Telephone Number	:	323-295-5446
Fax Number	:	323-295-2117

Provider Business Practice Location Address
First Line	:	4361 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-1651
Country	:	US
Telephone Number	:	323-295-5446
Fax Number	:	323-295-2117

Authorized Official
Title or Position	:	OWNER
Name	:	CLIFTON V LEE
Credential	:	MD
Telephone Number	:	323-295-5446

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	08/08/2012

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Directions to “HALEY & LEE INC ” Practice Location

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