=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922098797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAMONT R LEE PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2005
-----------------------------------------------------
Last Update Date | 10/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29645 RANCHO CALIFORNIA RD 109
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92591-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-296-0323
-----------------------------------------------------
Fax | 951-296-0326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24645 RANCHO CALIF RD STE 109
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-296-0323
-----------------------------------------------------
Fax | 951-296-0326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY5254
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------