Organization
GRAND MEDISPA GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS T. LEE M.D. (OWNER)
(909) 902-1401
Entity
Organization
Contact information
Practice address
13768 ROSWELL AVE STE 121, CHINO, CA 91710-1404
(909) 902-1401
(909) 902-6317
Mailing address
13768 ROSWELL AVENUE STE 121, CHINO, CA 91710-1404
(909) 902-1401
(909) 902-6317
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A37294
CA
207Q00000X
Family Medicine Physician
G48262
CA
207V00000X
Obstetrics & Gynecology Physician
A37294
CA
207V00000X
Obstetrics & Gynecology Physician
G48262
CA
207YS0123X
Facial Plastic Surgery Physician
G48262
CA
208200000X
Plastic Surgery Physician
G48262
CA
208600000X
Surgery Physician
Primary
G48262
CA
2086X0206X
Surgical Oncology Physician
G48262
AZ
208D00000X
General Practice Physician
G48262
CA
208VP0000X
Pain Medicine Physician
G48262
CA
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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