Basic Information
| Provider Information | |||||||||
| NPI: | 1003008855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | ALISIA | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1014 SAN JUAN AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595927300 | ||||||||
| FaxNumber: | 5596246590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 SAN JUAN AVE | ||||||||
| Address2: | |||||||||
| City: | EXETER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932211312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595927300 | ||||||||
| FaxNumber: | 5596246590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2007 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA19311 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.