Healthcare Provider Details

I. General information

NPI: 1174091326
Provider Name (Legal Business Name): ANNE K LE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17762 BEACH BLVD. STE. 220
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

17762 BEACH BLVD. STE. 220
HUNTINGTON BEACH CA
92647
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-0080
  • Fax: 714-665-4679
Mailing address:
  • Phone: 714-848-0080
  • Fax: 714-665-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA56228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: