Healthcare Provider Details

I. General information

NPI: 1639190028
Provider Name (Legal Business Name): ROLAND ROBERT LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MED CENTER/UCSD RADIOLOGY # MC114 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

VA MED CENTER/UCSD RADIOLOGY # MC114 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-552-7565
Mailing address:
  • Phone: 858-552-8585
  • Fax: 858-552-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG57800
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberG57800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: