Provider Demographics
NPI:1669836755
Name:LEE, DANIELS (CMT)
Entity Type:Individual
Prefix:
First Name:DANIELS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 4TH AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1834
Mailing Address - Country:US
Mailing Address - Phone:415-894-9696
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST
Practice Address - Street 2:SUITE 210-C
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:415-894-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist