1568682565 NPI number — PAMELA J LEE PHD, LAC

Table of content: PAMELA J LEE PHD, LAC (NPI 1568682565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568682565 NPI number — PAMELA J LEE PHD, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
PAMELA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568682565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
939 OAK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASO ROBLES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-237-1011
Provider Business Mailing Address Fax Number:
805-237-2788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
939 OAK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASO ROBLES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-237-1011
Provider Business Practice Location Address Fax Number:
805-237-2788
Provider Enumeration Date:
05/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC2757 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)