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NPI Code Detail

MEDICARE: DR. JAMES LEE PROFIT PH.D.

MEDICARE: DR. JAMES LEE PROFIT PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) PsychologistLCI04320815CA

General Provider Information

NPI Number : 1144736000
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES LEE PROFIT PH.D.
Provider Business Mailing Address
First Line : 1081 CAMINO DEL RIO S STE 103
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1081 CAMINO DEL RIO S STE 103
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3543
Country : US
Telephone Number : 619-926-6707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2017
Last Update Date : 12/14/2017

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