Provider Demographics
NPI:1952394025
Name:LEE, GLORIA LO (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LO
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1000 NEWBURY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6437
Mailing Address - Country:US
Mailing Address - Phone:805-214-3122
Mailing Address - Fax:805-214-3129
Practice Address - Street 1:1000 NEWBURY RD STE 130
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6437
Practice Address - Country:US
Practice Address - Phone:805-214-3122
Practice Address - Fax:805-214-3129
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC51138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72218Medicare UPIN