Provider Demographics
NPI:1871711838
Name:LEE, SANDRA (LAC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:164 EL DORADO AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3848
Mailing Address - Country:US
Mailing Address - Phone:925-876-8049
Mailing Address - Fax:
Practice Address - Street 1:1776 YGNACIO VALLEY RD
Practice Address - Street 2:STE 208
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3190
Practice Address - Country:US
Practice Address - Phone:925-876-8049
Practice Address - Fax:925-979-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist