Healthcare Provider Details

I. General information

NPI: 1770225864
Provider Name (Legal Business Name): CLIFTON LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TUSTIN AVE STE 400
SANTA ANA CA
92705-3850
US

IV. Provider business mailing address

300 S MOUNTAIN AVE # 1061
UPLAND CA
91786-7016
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-5391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA188826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: