Healthcare Provider Details

I. General information

NPI: 1376203182
Provider Name (Legal Business Name): PHYBIE MAI LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17011 BEACH BLVD STE 300
HUNTINGTON BEACH CA
92647-5950
US

IV. Provider business mailing address

17011 BEACH BLVD STE 300
HUNTINGTON BEACH CA
92647-5950
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-2620
  • Fax:
Mailing address:
  • Phone: 714-378-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: