Provider Demographics
NPI:1881750842
Name:LEE, ELAINE C (MPH, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 HOMESTEAD RD
Mailing Address - Street 2:BLDG 1, 2ND FLOOR
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0712
Mailing Address - Country:US
Mailing Address - Phone:408-366-4123
Mailing Address - Fax:408-366-4111
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:BLDG 1, 2ND FLOOR
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4123
Practice Address - Fax:408-366-4111
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA931932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered