Provider Demographics
NPI:1487094918
Name:LEE, NICOLE DANIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23326 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3725
Mailing Address - Country:US
Mailing Address - Phone:310-257-7205
Mailing Address - Fax:310-598-3117
Practice Address - Street 1:705 PIER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3941
Practice Address - Country:US
Practice Address - Phone:310-939-7847
Practice Address - Fax:310-939-7898
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA134509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program