Healthcare Provider Details

I. General information

NPI: 1669376323
Provider Name (Legal Business Name): ROBERT EARL LEE III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TREY E LEE III

II. Dates (important events)

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

III. Provider practice location address

2911 MERIDIEN CIR
UNION CITY CA
94587-1674
US

IV. Provider business mailing address

2911 MERIDIEN CIR
UNION CITY CA
94587-1674
US

V. Phone/Fax

Practice location:
  • Phone: 510-294-9383
  • Fax:
Mailing address:
  • Phone: 510-294-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: