Provider Demographics
NPI:1023286648
Name:BRENDA S LEE
Entity type:Organization
Organization Name:BRENDA S LEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:310-453-0815
Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#1033
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2118 WILSHIRE BLVD
Practice Address - Street 2:#1033
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5784
Practice Address - Country:US
Practice Address - Phone:310-453-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362531364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperativeGroup - Single Specialty