Provider Demographics
NPI:1508091257
Name:LEE ANDERSON, ANDREA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:LEE ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:MC 1509
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4499
Mailing Address - Fax:909-558-0428
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:MC 1509
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4499
Practice Address - Fax:909-558-0428
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA490328OtherMEDI-CAL DOCUMENT NUMBER
CAA113535OtherCA STATE LIC
CA1508091257OtherNPI