Healthcare Provider Details

I. General information

NPI: 1225547607
Provider Name (Legal Business Name): YOLANDA D MITCHELL-LEE PA12002
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOLANDA D LEE PA12002

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S APRILIA AVE
COMPTON CA
90220-3418
US

IV. Provider business mailing address

531 S APRILIA AVE
COMPTON CA
90220-3418
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-7058
  • Fax:
Mailing address:
  • Phone: 310-537-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPA12002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: