Provider Demographics
NPI:1467449082
Name:LEE, LI FLORENCE (NP)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:FLORENCE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-838-9677
Mailing Address - Fax:
Practice Address - Street 1:8311 FLORENCE AVE.
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240
Practice Address - Country:US
Practice Address - Phone:562-923-4911
Practice Address - Fax:562-904-2060
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA003627420OtherMEDI CAL
CA003627420OtherMEDI CAL