Healthcare Provider Details

I. General information

NPI: 1114996436
Provider Name (Legal Business Name): MARIA IVONNE LEE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 LOMBARD ST
SAN FRANCISCO CA
94133-2217
US

IV. Provider business mailing address

961 LOMBARD ST
SAN FRANCISCO CA
94133-2217
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-379-5512
Mailing address:
  • Phone: 415-221-4810
  • Fax: 415-379-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number418256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: