Provider Demographics
NPI:1013798404
Name:LEE, KAREN PAULA (RD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PAULA
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 LAKERIDGE CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2369
Mailing Address - Country:US
Mailing Address - Phone:559-296-6901
Mailing Address - Fax:
Practice Address - Street 1:1662 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5231
Practice Address - Country:US
Practice Address - Phone:858-230-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86082403133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered