Provider Demographics
NPI:1982748935
Name:LEE, IRENE C (PT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 N WOLFE RD
Mailing Address - Street 2:SW3-100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2515
Mailing Address - Country:US
Mailing Address - Phone:408-342-6600
Mailing Address - Fax:408-342-6655
Practice Address - Street 1:10080 N WOLFE RD
Practice Address - Street 2:SUITE 3-100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2515
Practice Address - Country:US
Practice Address - Phone:408-342-6600
Practice Address - Fax:408-342-6655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 1943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist