Healthcare Provider Details

I. General information

NPI: 1306621156
Provider Name (Legal Business Name): MARGARET LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA LEE

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 NANCY LOPEZ BLVD
RIO COMMUNITIES NM
87002-7045
US

IV. Provider business mailing address

1805 NANCY LOPEZ BLVD
RIO COMMUNITIES NM
87002-7045
US

V. Phone/Fax

Practice location:
  • Phone: 505-985-2201
  • Fax:
Mailing address:
  • Phone: 505-985-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: