Provider Demographics
NPI:1811796568
Name:LEE, BRENDA LIZETTE (RDHAP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LIZETTE
Last Name:LEE
Suffix:
Gender:
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 COUNTRY MILE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0030
Mailing Address - Country:US
Mailing Address - Phone:909-260-2161
Mailing Address - Fax:
Practice Address - Street 1:825 TRI CITY CTR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2859
Practice Address - Country:US
Practice Address - Phone:909-260-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist