Healthcare Provider Details

I. General information

NPI: 1427967165
Provider Name (Legal Business Name): ANDREA LEE CMT, CST-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 S AMPHLETT BLVD STE 120
SAN MATEO CA
94402-2512
US

IV. Provider business mailing address

1670 S AMPHLETT BLVD STE 120
SAN MATEO CA
94402-2512
US

V. Phone/Fax

Practice location:
  • Phone: 650-762-9283
  • Fax:
Mailing address:
  • Phone: 650-762-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number57142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: