Healthcare Provider Details

I. General information

NPI: 1699110890
Provider Name (Legal Business Name): ERIK LEE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 07/17/2022
Certification Date: 07/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD FL 4
TIGARD OR
97223-5500
US

IV. Provider business mailing address

6161 EL CAJON BLVD STE B-458
SAN DIEGO CA
92115-3922
US

V. Phone/Fax

Practice location:
  • Phone: 888-923-5486
  • Fax: 866-225-9111
Mailing address:
  • Phone: 619-374-8131
  • Fax: 415-366-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95002431
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202100624NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1841784725
Identifier TypeOTHER
Identifier State
Identifier IssuerNPPES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: