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General NPI Number Information
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NPI Number | 1417482688
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Entity Type | Individual
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Provider Name | REBECCA LEE
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1300 N MISSION RD
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City | LOS ANGELES
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State | CA
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Zip | 90033-1021
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Country | US
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Telephone | 323-409-6484
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N MISSION RD
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City | LOS ANGELES
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State | CA
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Zip | 90033-1021
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Country | US
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Telephone | 323-409-6484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A16868
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License Number State | CA
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