Provider Demographics
NPI:1780601534
Name:RAZALAN, LEE G (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:G
Last Name:RAZALAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3033
Mailing Address - Country:US
Mailing Address - Phone:562-424-4661
Mailing Address - Fax:562-427-3333
Practice Address - Street 1:2511 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3033
Practice Address - Country:US
Practice Address - Phone:562-424-4661
Practice Address - Fax:562-427-3333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308840Medicaid
CA00A30884Medicare UPIN
CAA30884Medicare UPIN
CAA84141Medicare UPIN