Provider Demographics
NPI:1083981617
Name:LEE, GARTH GETTY
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:GETTY
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1037
Mailing Address - Country:US
Mailing Address - Phone:760-753-1293
Mailing Address - Fax:760-753-1298
Practice Address - Street 1:1763 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1037
Practice Address - Country:US
Practice Address - Phone:760-753-1293
Practice Address - Fax:760-753-1298
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE21802261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care