=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134086523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIKA MIRANDA LEE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 S SUNSET AVE
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-813-2961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15811 MINERAL KING AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91708-9226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-347-1723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0106X
-----------------------------------------------------
Taxonomy Name | Occupational Health Nurse Practitioner
-----------------------------------------------------
License Number | 95024150
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------