Provider Demographics
NPI:1013459494
Name:LEE, ON NA (MAS, RD)
Entity Type:Individual
Prefix:
First Name:ON NA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MAS, RD
Other - Prefix:
Other - First Name:ONNA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAS, RD
Mailing Address - Street 1:PO BOX 3364
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-0364
Mailing Address - Country:US
Mailing Address - Phone:415-999-8160
Mailing Address - Fax:
Practice Address - Street 1:1855 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2350
Practice Address - Country:US
Practice Address - Phone:415-999-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL999113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered