Basic Information
| Provider Information | |||||||||
| NPI: | 1679139828 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEE | ||||||||
| FirstName: | MOSES | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF ORTHOPAEDIC SURGERY RM. B2042 RUHS-MC | ||||||||
| Address2: | 26520 CACTUS AVE. | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514864698 | ||||||||
| FaxNumber: | 9514864106 | ||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF ORTHOPAEDIC SURGERY RM. B2042 RUHS-MC | ||||||||
| Address2: | 26520 CACTUS AVE. | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514864698 | ||||||||
| FaxNumber: | 9514864106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2019 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.