Provider Demographics
NPI:1578952172
Name:LEE, DONNA ELANE (LMT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ELANE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:ELANE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37250 SEQUOIA CMN APT 1031
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1929
Mailing Address - Country:US
Mailing Address - Phone:510-314-7606
Mailing Address - Fax:
Practice Address - Street 1:37250 SEQUOIA CMN
Practice Address - Street 2:1031
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1928
Practice Address - Country:US
Practice Address - Phone:510-314-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist