Provider Demographics
NPI:1861514390
Name:LEE, CHRISTINE (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19328 NORAH AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7346
Mailing Address - Country:US
Mailing Address - Phone:949-770-5843
Mailing Address - Fax:949-770-9546
Practice Address - Street 1:23293 S POINTE DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1447
Practice Address - Country:US
Practice Address - Phone:949-770-5843
Practice Address - Fax:949-770-9546
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5377225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics