MEDICARE: PAMELA LEE MPH, RD, CDE

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	207R00000X	Internal Medicine Physician	803731	CA
2	133V00000X	Registered Dietitian	803731	CA
3	133NN1002X	Nutrition Education Nutritionist	803731	CA
4	132700000X	Dietary Manager	803731	CA
5	133VN1006X	Metabolic Nutrition Registered Dietitian	803731	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912019803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LEE MPH, RD, CDE

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5632
Country	:	US
Telephone Number	:	310-828-7172
Fax Number	:	310-828-8662

Provider Business Practice Location Address
First Line	:	1801 WILSHIRE BLVD
Second Line	:	100
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5609
Country	:	US
Telephone Number	:	310-828-7172
Fax Number	:	310-828-8662

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/19/2010

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