Provider Demographics
NPI:1982954103
Name:LEE, VIRGINA (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINA
Other - Middle Name:
Other - Last Name:AZOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 EXPOSITION BLVD # 700
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-649-9800
Mailing Address - Fax:
Practice Address - Street 1:1111 EXPOSITION BLVD # 700
Practice Address - Street 2:SUITE 102
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-649-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122362208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics