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General NPI Number Information
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NPI Number | 1639135098
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Entity Type | Individual
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Provider Name | AMY LEE MD, FACE, FACGS
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 3975 JACKSON ST SUITE 105
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City | RIVERSIDE
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State | CA
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Zip | 92503-3901
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Country | US
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Telephone | 951-343-3388
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Fax | 951-343-3388
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Provider Business Mailing Address
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Address Line | 3975 JACKSON STREET SUITE 105
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 951-343-3388
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Fax | 951-343-3388
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 103002
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License Number State | MO
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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 | A38003
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License Number State | CA
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