Provider Demographics
NPI:1659545077
Name:CATES, LEE THOMAS
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:THOMAS
Last Name:CATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5208
Mailing Address - Country:US
Mailing Address - Phone:650-817-9070
Mailing Address - Fax:650-817-9074
Practice Address - Street 1:505 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2922
Practice Address - Country:US
Practice Address - Phone:650-380-6149
Practice Address - Fax:650-952-5846
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC5160802171M00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ-80499ZOther174400000X
CA174400000Other174400000X