Provider Demographics
NPI:1922365527
Name:LEE, LORETTA M (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
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 1:10941 LIMETREE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2453
Mailing Address - Country:US
Mailing Address - Phone:714-730-1679
Mailing Address - Fax:
Practice Address - Street 1:600 W SANTA ANA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4544
Practice Address - Country:US
Practice Address - Phone:714-565-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA345132083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine