Provider Demographics
NPI:1376946962
Name:LEE, ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 CAMINO RAMON STE 180
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2060
Mailing Address - Country:US
Mailing Address - Phone:925-866-1005
Mailing Address - Fax:925-866-1006
Practice Address - Street 1:2301 CAMINO RAMON STE 180
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2060
Practice Address - Country:US
Practice Address - Phone:925-866-1005
Practice Address - Fax:925-866-1006
Is Sole Proprietor?:No
Enumeration Date:2014-09-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA51989363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant