Provider Demographics
NPI:1225547607
Name:MITCHELL-LEE, YOLANDA D (PA12002)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:D
Last Name:MITCHELL-LEE
Suffix:
Gender:F
Credentials:PA12002
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:D
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA12002
Mailing Address - Street 1:531 S APRILIA AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3418
Mailing Address - Country:US
Mailing Address - Phone:310-537-7058
Mailing Address - Fax:
Practice Address - Street 1:531 S APRILIA AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3418
Practice Address - Country:US
Practice Address - Phone:310-537-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12002171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider