Healthcare Provider Details

I. General information

NPI: 1215478318
Provider Name (Legal Business Name): KARELYA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 LUSK BLVD STE C256
SAN DIEGO CA
92121-5795
US

IV. Provider business mailing address

1663 MISSION ST STE 400
SAN FRANCISCO CA
94103-2485
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 877-539-7730
Mailing address:
  • Phone: 877-264-6747
  • Fax: 877-539-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: