Healthcare Provider Details

I. General information

NPI: 1447597349
Provider Name (Legal Business Name): LEE ANN MARIE CUNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 TENNESSEE ST
VALLEJO CA
94590-4627
US

IV. Provider business mailing address

1502 TENNESSEE ST
VALLEJO CA
94590-4627
US

V. Phone/Fax

Practice location:
  • Phone: 707-474-2263
  • Fax: 707-471-6519
Mailing address:
  • Phone: 707-474-2263
  • Fax: 707-471-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEE ANN MARIE CUNY
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 707-474-2263