Provider Demographics
NPI:1639453152
Name:LEE, PEGGY CHAO I
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:CHAO I
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BON VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-4408
Mailing Address - Country:US
Mailing Address - Phone:909-930-6793
Mailing Address - Fax:909-930-6798
Practice Address - Street 1:1515 S BON VIEW AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4408
Practice Address - Country:US
Practice Address - Phone:909-930-6793
Practice Address - Fax:909-930-6798
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist