Provider Demographics
NPI:1710280383
Name:LEE, CHRISTEN (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:
Other - Last Name:BUIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 TERRACINA BLVD STE 205C
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4870
Mailing Address - Country:US
Mailing Address - Phone:909-793-2323
Mailing Address - Fax:909-793-2324
Practice Address - Street 1:255 TERRACINA BLVD STE 205C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2323
Practice Address - Fax:909-793-2324
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19960363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical