Healthcare Provider Details

I. General information

NPI: 1770098493
Provider Name (Legal Business Name): ANDREA NICOLE LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10666 N TORREY PINES RD # MS 313
LA JOLLA CA
92037
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD # 4S-205
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-8203
  • Fax: 858-554-6954
Mailing address:
  • Phone: 858-554-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number55194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: