Provider Demographics
NPI:1760985378
Name:LEE, PHYLLIS JEAN
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:JEAN
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 1:304 DILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78203-1806
Mailing Address - Country:US
Mailing Address - Phone:210-415-7339
Mailing Address - Fax:
Practice Address - Street 1:304 DILWORTH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203-1806
Practice Address - Country:US
Practice Address - Phone:210-415-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator