Healthcare Provider Details

I. General information

NPI: 1366703118
Provider Name (Legal Business Name): MUI LEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 CULEBRA RD STE 104
SAN ANTONIO TX
78251-2891
US

IV. Provider business mailing address

9018 CULEBRA RD STE 104
SAN ANTONIO TX
78251-2891
US

V. Phone/Fax

Practice location:
  • Phone: 830-276-2600
  • Fax: 830-276-2626
Mailing address:
  • Phone: 830-276-2600
  • Fax: 830-276-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberPA07112
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA07112
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA07112
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA07112
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: