1881663540 NPI number — SHERYL ANN LEE OT

Table of content: SHERYL ANN LEE OT (NPI 1881663540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881663540 NPI number — SHERYL ANN LEE OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
SHERYL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POBLETE
Provider Other First Name:
SHERYL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881663540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4482 BARRANCA PKWY
Provider Second Line Business Mailing Address:
STE 195
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-7701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-679-3337
Provider Business Mailing Address Fax Number:
949-679-3336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4482 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
STE 195
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-679-3337
Provider Business Practice Location Address Fax Number:
949-679-3336
Provider Enumeration Date:
03/15/2006

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: 225X00000X , with the licence number:  OT1503 , 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)

  • Identifier: AZ229X . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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