Individual
MR. NATHAN RYAN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
810 E CHAPMAN AVE, SUITE C, FULLERTON, CA 92831-3850
(714) 626-0417
(714) 626-0319
Mailing address
810 E CHAPMAN AVE, SUITE C, FULLERTON, CA 92831-3850
(714) 626-0417
(714) 626-0319
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CPO 02709
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XC0027090
MEDI-CAL RENDERING
CA
Enumeration date
07/26/2007
Last updated
08/01/2022
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