Healthcare Provider Details

I. General information

NPI: 1508436320
Provider Name (Legal Business Name): CMLEEJR MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 10/17/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 W SAN MARCOS BLVD STE 112
SAN MARCOS CA
92078-1244
US

IV. Provider business mailing address

727 W SAN MARCOS BLVD STE 112
SAN MARCOS CA
92078-1244
US

V. Phone/Fax

Practice location:
  • Phone: 760-405-8400
  • Fax: 760-405-8401
Mailing address:
  • Phone: 760-405-8400
  • Fax: 760-405-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARENCE MARCUS LEE JR.
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 760-405-8400