Provider Demographics
NPI:1114556974
Name:LEE, BRIGETTE MARY (MD)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:MARY
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25865 BARTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3896
Mailing Address - Country:US
Mailing Address - Phone:909-558-2890
Mailing Address - Fax:
Practice Address - Street 1:25865 BARTON RD STE 101
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3896
Practice Address - Country:US
Practice Address - Phone:909-558-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA193626207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology