Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60938 | CA |
N | 1223D0001X | Dental Public Health | 60938 | CA |
NPI | 1104194893 |
---|---|
Provider Name | Dr. Marisa Mei Lin Lee |
First Address | San Diego, CA 92169-0903 |
Second Address | Vista, CA 92084-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2011 |
Last Update Date | 08/12/2011 |