Provider Demographics
NPI:1639135098
Name:LEE, AMY (MD, FACE, FACGS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, FACE, FACGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 JACKSON STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-343-3388
Mailing Address - Fax:951-343-3388
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-343-3388
Practice Address - Fax:951-343-3388
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103002207R00000X
CAA38003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine