Healthcare Provider Details

I. General information

NPI: 1881559128
Provider Name (Legal Business Name): MELISSA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1819
US

IV. Provider business mailing address

11344 CAMPUS ST
LOMA LINDA CA
92354-3302
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-1444
  • Fax:
Mailing address:
  • Phone: 909-583-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95064309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: