Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 16642 | CA |
NPI | 1003956012 |
---|---|
Provider Name | Ms. Kia Lee |
First Address | San Diego, CA 92115-5268 |
Second Address | National City, CA 91950-2957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |