MEDICARE: ANNA E LEE MD

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	208000000X	Pediatrics Physician	G 79537	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G 79537	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1619949443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA E LEE MD

Provider Business Mailing Address
First Line	:	3998 VISTA WAY STE D
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4514
Country	:	US
Telephone Number	:	760-295-1995
Fax Number	:	760-295-1118

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY STE D
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4514
Country	:	US
Telephone Number	:	760-295-1995
Fax Number	:	760-295-1118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	01/21/2021

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Directions to “ ANNA E LEE MD” Practice Location

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