Active NPI
Russell Raymond Lee, PT
- Specialist
- Castaic, CA
National Provider Identifier
1467532150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT 5791
- Practice address
- 31884 Castaic Rd
Suite C-3
Castaic, CA 91384-3946 - Phone
- (661) 295-0078
- Fax
- (661) 295-6783
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT 5791 | CA | Primary |
Addresses
Primary practice location
31884 Castaic Rd
Suite C-3
Castaic, CA 91384-3946
Mailing address
31884 Castaic Rd
Suite C-3
Castaic, CA 91384-3946
Phone (661) 295-0078
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 5791 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467532150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31884 CASTAIC RD",
"address_2": "SUITE C-3",
"city": "CASTAIC",
"state": "CA",
"postal_code": "913843946",
"telephone_number": "661-295-0078",
"fax_number": "661-295-6783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31884 CASTAIC RD",
"address_2": "SUITE C-3",
"city": "CASTAIC",
"state": "CA",
"postal_code": "913843946",
"telephone_number": "661-295-0078",
"fax_number": "661-295-6783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "RUSSELL",
"middle_name": "RAYMOND",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "PT 5791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Castaic, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.