MEDICARE: CYNTHIA S LEE NP

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
1	163WN0002X	Neonatal Intensive Care Registered Nurse	635290	CA
2	363L00000X	Nurse Practitioner	95002922	CA

General Provider Information

NPI Number	:	1700239472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA S LEE NP

Provider Business Mailing Address
First Line	:	24148 DECORAH RD
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1411
Country	:	US
Telephone Number	:	951-201-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	4085 GRAND AVE STE 3
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5438
Country	:	US
Telephone Number	:	909-282-2678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	05/05/2025

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