Provider Demographics
NPI:1003134552
Name:ANG LEE, ROMEO V
Entity Type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:V
Last Name:ANG LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROMEO
Other - Middle Name:V
Other - Last Name:ANG LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1826 TAFT LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7438
Mailing Address - Country:US
Mailing Address - Phone:714-529-2176
Mailing Address - Fax:714-529-8834
Practice Address - Street 1:405 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4818
Practice Address - Country:US
Practice Address - Phone:714-529-2176
Practice Address - Fax:714-529-8834
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist