Healthcare Provider Details

I. General information

NPI: 1538893789
Provider Name (Legal Business Name): DANIELLE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 MELROSE AVE
LOS ANGELES CA
90038-3144
US

IV. Provider business mailing address

1654 LA RAMADA AVE
ARCADIA CA
91006-1822
US

V. Phone/Fax

Practice location:
  • Phone: 323-653-1990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: