Provider Demographics
NPI:1619165040
Name:LEE BURNETT DO A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LEE BURNETT DO A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH-ARDREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-421-0709
Mailing Address - Street 1:26161 MARGUERITE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3203
Mailing Address - Country:US
Mailing Address - Phone:949-582-8584
Mailing Address - Fax:
Practice Address - Street 1:26922 OSO PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5800
Practice Address - Country:US
Practice Address - Phone:949-582-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH02146Medicare UPIN