Healthcare Provider Details

I. General information

NPI: 1669216990
Provider Name (Legal Business Name): BRENDA SUE LEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 S SEPULVEDA BLVD APT 3
LOS ANGELES CA
90034-5239
US

IV. Provider business mailing address

3310 S SEPULVEDA BLVD APT 3
LOS ANGELES CA
90034-5239
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-1060
  • Fax:
Mailing address:
  • Phone: 310-880-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number362531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: