Healthcare Provider Details

I. General information

NPI: 1609571785
Provider Name (Legal Business Name): ALICE LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON STREET GME OFFICE WESTERLY SUITE C
LOMA LINDA CA
92354
US

IV. Provider business mailing address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6688
  • Fax:
Mailing address:
  • Phone: 201-418-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB13129100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: