Provider Demographics
NPI:1265613384
Name:LEE, CRISTI L (PA)
Entity type:Individual
Prefix:MS
First Name:CRISTI
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:6320B W UNION HILLS DR
Practice Address - Street 2:STE B2300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7201
Practice Address - Country:US
Practice Address - Phone:623-561-9113
Practice Address - Fax:623-561-6148
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2013-09-24
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Provider Licenses
StateLicense IDTaxonomies
AZ3736363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1174514756OtherBILLING GROUP