Healthcare Provider Details

I. General information

NPI: 1245980408
Provider Name (Legal Business Name): MICHAEL SUTHERLAND LEE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25170 HANCOCK AVE STE 200
MURRIETA CA
92562-5969
US

IV. Provider business mailing address

25170 HANCOCK AVE STE 200
MURRIETA CA
92562-5969
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9300
  • Fax: 951-461-9399
Mailing address:
  • Phone: 951-461-9300
  • Fax: 951-461-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA189225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: