Individual
MIKE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
645 S BARRANCA ST, WEST COVINA, CA 91791-2943
(626) 974-6220
Mailing address
2207 N VERDUGO RD APT 2, GLENDALE, CA 91208-2543
(818) 425-9209
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000029397
CA
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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