Provider Demographics
NPI:1689111890
Name:HAGANS, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:HAGANS
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 1:19083 BEAR VALLEY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-2719
Mailing Address - Country:US
Mailing Address - Phone:760-240-5700
Mailing Address - Fax:760-240-7900
Practice Address - Street 1:3603 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3514
Practice Address - Country:US
Practice Address - Phone:951-925-9961
Practice Address - Fax:951-925-1013
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7683237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist