Provider Demographics
NPI:1902464365
Name:LEE, LORENA (DAOM, LAC, DIPLOM)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DAOM, LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE STE B210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5499
Mailing Address - Country:US
Mailing Address - Phone:858-366-8833
Mailing Address - Fax:
Practice Address - Street 1:5222 BALBOA AVE STE 21
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6948
Practice Address - Country:US
Practice Address - Phone:858-366-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005325171100000X
CA16157171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA