Provider Demographics
NPI:1215696620
Name:LEE, JANET PEARL (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:PEARL
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 N ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3413
Mailing Address - Country:US
Mailing Address - Phone:408-499-5522
Mailing Address - Fax:
Practice Address - Street 1:619 N ACACIA AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3413
Practice Address - Country:US
Practice Address - Phone:408-499-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802379163WE0003X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency