Provider Demographics
NPI:1881455921
Name:LEE, GLORIA TAYLOR
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:TAYLOR
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MAEGAN PL APT 5
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2764
Mailing Address - Country:US
Mailing Address - Phone:323-990-1661
Mailing Address - Fax:
Practice Address - Street 1:122 MAEGAN PL APT 5
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2764
Practice Address - Country:US
Practice Address - Phone:323-990-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program