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General NPI Number Information
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NPI Number | 1649090077
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Entity Type | Individual
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Provider Name | RYAN J LEE PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 515 NEW JERSEY ST STE A
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City | REDLANDS
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State | CA
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Zip | 92373-6249
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Country | US
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Telephone | 909-880-4200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 221
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City | MENTONE
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State | CA
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Zip | 92359-0221
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Country | US
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Telephone | 909-353-9172
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032558
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License Number State | CA
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