Provider Demographics
NPI:1982853594
Name:LEE, TIMESHA ANJEANETTE
Entity Type:Individual
Prefix:MISS
First Name:TIMESHA
Middle Name:ANJEANETTE
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 1:2648 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1506
Mailing Address - Country:US
Mailing Address - Phone:925-465-1387
Mailing Address - Fax:925-978-1775
Practice Address - Street 1:512 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1236
Practice Address - Country:US
Practice Address - Phone:925-465-1387
Practice Address - Fax:925-978-1775
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator