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General NPI Number Information
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NPI Number | 1609272699
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Entity Type | Individual
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Provider Name | MICHELLE LEE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 8641 WILSHIRE BLVD SUITE #215
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2900
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Country | US
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Telephone | 310-777-7845
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 DEL MONTE CT
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City | FAIRFIELD
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State | CA
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Zip | 94534-7113
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Country | US
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Telephone | 707-372-4190
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52161
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License Number State | CA
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