Provider Demographics
NPI:1225807324
Name:LEE, GLORIA H (LAC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:H
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1320 W PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4018
Mailing Address - Country:US
Mailing Address - Phone:714-767-5890
Mailing Address - Fax:
Practice Address - Street 1:439 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1229
Practice Address - Country:US
Practice Address - Phone:714-623-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist