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General NPI Number Information
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NPI Number | 1497626337
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Entity Type | Organization
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Legal Business Name | BLAINE ROBERT LEE, PSYCHIATRIC MENTAL HEALTH NURSING PRACTICE INC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 431 W LAMBERT RD STE 310
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City | BREA
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State | CA
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Zip | 92821-3918
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Country | US
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Telephone | 714-325-7110
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Fax | 949-346-4026
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Provider Business Mailing Address
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Address Line | 431 W LAMBERT RD STE 310
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City | BREA
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State | CA
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Zip | 92821-3918
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Country | US
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Telephone | 714-325-7110
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Fax | 949-346-4026
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | BLAINE ROBERT LEE
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Credential | PMHNP-BC
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Telephone | 714-325-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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