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NPI Code Detail

MEDICARE: ANGELA RENEE LEE PA-C

MEDICARE: ANGELA RENEE LEE PA-C
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
1363AM0700XMedical Physician AssistantPA14169CA

General Provider Information

NPI Number : 1821269135
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA RENEE LEE PA-C
Provider Business Mailing Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number : 310-549-2277
Provider Business Practice Location Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number : 310-549-2277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2008
Last Update Date : 05/27/2020

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