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General NPI Number Information
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NPI Number | 1376049049
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Entity Type | Organization
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Legal Business Name | LEE RICE D.O. MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2448 HISTORIC DECATUR RD STE 130
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City | SAN DIEGO
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State | CA
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Zip | 92106-6127
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Country | US
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Telephone | 619-398-2960
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Fax | 619-398-2970
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Provider Business Mailing Address
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Address Line | 2448 HISTORIC DECATUR RD STE 130
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City | SAN DIEGO
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State | CA
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Zip | 92106-6127
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Country | US
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Telephone | 619-398-2960
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Fax | 619-398-2970
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID M LARSON
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Credential | MD
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Telephone | 619-398-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A122666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 20A3360
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A122666
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A3360
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License Number State | CA
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