Healthcare Provider Details

I. General information

NPI: 1700026549
Provider Name (Legal Business Name): STEPHEN B. LEE MEDICAL CORPORATION AT COACHELLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52565 HARRISON ST UNIT 104
COACHELLA CA
92236-1534
US

IV. Provider business mailing address

52565 HARRISON ST UNIT 104
COACHELLA CA
92236-1534
US

V. Phone/Fax

Practice location:
  • Phone: 760-398-0606
  • Fax: 760-398-5507
Mailing address:
  • Phone: 760-398-0606
  • Fax: 760-398-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN B. LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-865-5214