Healthcare Provider Details

I. General information

NPI: 1215023643
Provider Name (Legal Business Name): SOLEDAD O LEE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

6888 LINCOLN AVE SUITE 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 Code251T00000X
TaxonomyPACE Provider Organization
License NumberA 35051
License Number StateCA

VIII. Authorized Official

Name: SOLEDAD O LEE
Title or Position: OWNER
Credential: MD
Phone: 714-828-8400