Individual
HEATHER NICOLE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2450 ASHBY AVE, ROMM 5505, BERKELEY, CA 94705-2067
(510) 204-1893
Mailing address
3687 MT DIABLO BLVD, SUITE 200, LAFAYETTE, CA 94549-3717
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A126670
CA
208M00000X
Hospitalist Physician
Primary
A126670
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A126670
STATE LICENSE
CA
Enumeration date
04/20/2011
Last updated
05/18/2017
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