Provider Demographics
NPI:1699110890
Name:LEE, ERIK (PMHNP)
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 EL CAJON BLVD STE B-458
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3922
Mailing Address - Country:US
Mailing Address - Phone:619-374-8131
Mailing Address - Fax:415-366-0381
Practice Address - Street 1:10260 SW GREENBURG RD FL 4
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5500
Practice Address - Country:US
Practice Address - Phone:888-923-5486
Practice Address - Fax:866-225-9111
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002431363LP0808X
OR202100624NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841784725OtherNPPES