Provider Demographics
NPI:1174909816
Name:LEE, BRYAN PAUL (CNIM)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:PAUL
Last Name:LEE
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 RAVENCREST DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6050
Mailing Address - Country:US
Mailing Address - Phone:714-351-6686
Mailing Address - Fax:
Practice Address - Street 1:1811 RAVENCREST DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6050
Practice Address - Country:US
Practice Address - Phone:714-351-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic