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NPI Code Detail

MEDICARE: HAZEL AVELLANOSA LEE

MEDICARE: HAZEL AVELLANOSA LEE
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
1106H00000XMarriage & Family TherapistIMF74152CA

General Provider Information

NPI Number : 1861822603
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAZEL AVELLANOSA LEE
Provider Business Mailing Address
First Line : 10 DOUGLAS DR STE 140
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-4078
Country : US
Telephone Number : 925-313-1158
Fax Number : 925-313-1142
Provider Business Practice Location Address
First Line : 10 DOUGLAS DR STE 140
Second Line :
City : MARTINEZ
State : CA
Zip : 94553-4078
Country : US
Telephone Number : 925-313-1158
Fax Number : 925-313-1142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2013
Last Update Date : 07/21/2022

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Directions to “ HAZEL AVELLANOSA LEE ” Practice Location

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