Provider Demographics
NPI:1619949443
Name:LEE, ANNA E (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 VISTA WAY STE D
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4514
Mailing Address - Country:US
Mailing Address - Phone:760-295-1995
Mailing Address - Fax:760-295-1118
Practice Address - Street 1:3998 VISTA WAY STE D
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4514
Practice Address - Country:US
Practice Address - Phone:760-295-1995
Practice Address - Fax:760-295-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 79537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 79537OtherSTATE LICENSE