Provider Demographics
NPI:1467226373
Name:LEE, BLAINE ROBERT (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BLAINE ROBERT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 E IMPERIAL HWY # 1137
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:431 W LAMBERT RD STE 310
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3918
Practice Address - Country:US
Practice Address - Phone:714-325-7110
Practice Address - Fax:949-346-4026
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health