Healthcare Provider Details

I. General information

NPI: 1063609097
Provider Name (Legal Business Name): SOLEDAD O LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 LINCOLN AVE STE M
BUENA PARK CA
90620-4107
US

IV. Provider business mailing address

6888 LINCOLN AVE STE M
BUENA PARK CA
90620-4107
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-8400
  • Fax: 714-828-0202
Mailing address:
  • Phone: 714-828-8400
  • Fax: 714-828-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA35051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: