Provider Demographics
NPI:1386195543
Name:LEE, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
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 1:9145 LAS VEGAS BLVD S
Mailing Address - Street 2:D3042
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3308
Mailing Address - Country:US
Mailing Address - Phone:702-659-9977
Mailing Address - Fax:
Practice Address - Street 1:9145 LAS VEGAS BLVD S
Practice Address - Street 2:D3042
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3308
Practice Address - Country:US
Practice Address - Phone:702-659-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20161155833252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency