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General NPI Number Information
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NPI Number | 1386654143
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Entity Type | Organization
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Legal Business Name | MICHAEL WOMEN'S MEDICAL CLINIC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 920 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-4618
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Country | US
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Telephone | 909-623-3591
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Fax | 909-623-3504
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Provider Business Mailing Address
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Address Line | 920 N GAREY AVE
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City | POMONA
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State | CA
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Zip | 91767-4618
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Country | US
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Telephone | 909-623-3591
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Fax | 909-623-3504
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. ROBERT S LEE
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Credential | D.O.
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Telephone | 909-623-3591
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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