Provider Demographics
NPI:1659803880
Name:LEE, JAMIE M
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
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 1:2224 MOUNTAIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1319
Mailing Address - Country:US
Mailing Address - Phone:714-932-1886
Mailing Address - Fax:
Practice Address - Street 1:2224 MOUNTAIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1319
Practice Address - Country:US
Practice Address - Phone:714-932-1886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program