Provider Demographics
NPI:1700026549
Name:STEPHEN B. LEE MEDICAL CORPORATION AT COACHELLA
Entity Type:Organization
Organization Name:STEPHEN B. LEE MEDICAL CORPORATION AT COACHELLA
Other - Org Name:CLINICA MEDICA DEL VALLE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-865-5214
Mailing Address - Street 1:52565 HARRISON ST
Mailing Address - Street 2:UNIT 104
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1534
Mailing Address - Country:US
Mailing Address - Phone:760-398-0606
Mailing Address - Fax:760-398-5507
Practice Address - Street 1:52565 HARRISON ST
Practice Address - Street 2:UNIT 104
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1534
Practice Address - Country:US
Practice Address - Phone:760-398-0606
Practice Address - Fax:760-398-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty