Healthcare Provider Details

I. General information

NPI: 1992478671
Provider Name (Legal Business Name): MICHAEL LEE MEDICAL DOCTOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 DE LA VINA ST
SANTA BARBARA CA
93105-3819
US

IV. Provider business mailing address

PO BOX 1206
GOLETA CA
93116-1206
US

V. Phone/Fax

Practice location:
  • Phone: 805-687-7444
  • Fax: 805-687-3707
Mailing address:
  • Phone: 805-964-3838
  • Fax: 805-683-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEE
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 805-687-7444