Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 21025 | CA |
NPI | 1154948834 |
---|---|
Provider Name | Judy Esther Lee |
First Address | San Bernardino, CA 92408-3469 |
Second Address | San Bernardino, CA 92408-3469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2020 |
Last Update Date | 29/06/2020 |