Provider Demographics
NPI:1790125979
Name:LEE, CHARLOTTE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 VEREDA MAR DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8627
Mailing Address - Country:US
Mailing Address - Phone:913-706-8512
Mailing Address - Fax:
Practice Address - Street 1:4630 VEREDA MAR DEL SOL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-8627
Practice Address - Country:US
Practice Address - Phone:913-706-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27077174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator