Provider Demographics
NPI:1639882244
Name:LEE, RJ (RN, PHN)
Entity Type:Individual
Prefix:
First Name:RJ
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 STORY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1942
Mailing Address - Country:US
Mailing Address - Phone:408-494-1500
Mailing Address - Fax:
Practice Address - Street 1:1775 STORY RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1942
Practice Address - Country:US
Practice Address - Phone:408-494-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550628163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management