Provider Demographics
NPI:1912141169
Name:LEE, ROBERT M (LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8429
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92812-0429
Mailing Address - Country:US
Mailing Address - Phone:714-588-0499
Mailing Address - Fax:
Practice Address - Street 1:466 W SUMMERFIELD CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-4778
Practice Address - Country:US
Practice Address - Phone:714-588-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist