Provider Demographics
NPI:1952471963
Name:LEE, SANDRA MARLENE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARLENE
Last Name:LEE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5193 FRUITLAND RD
Mailing Address - Street 2:
Mailing Address - City:LOMA RICA
Mailing Address - State:CA
Mailing Address - Zip Code:95901-9505
Mailing Address - Country:US
Mailing Address - Phone:530-749-0581
Mailing Address - Fax:
Practice Address - Street 1:5193 FRUITLAND RD
Practice Address - Street 2:
Practice Address - City:LOMA RICA
Practice Address - State:CA
Practice Address - Zip Code:95901-9505
Practice Address - Country:US
Practice Address - Phone:530-749-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29507246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information