Provider Demographics
NPI:1194402875
Name:LEE, BRENDA ARIA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ARIA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 164TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5038
Mailing Address - Country:US
Mailing Address - Phone:310-706-1569
Mailing Address - Fax:
Practice Address - Street 1:711 W 164TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5038
Practice Address - Country:US
Practice Address - Phone:310-706-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist