Healthcare Provider Details

I. General information

NPI: 1295202398
Provider Name (Legal Business Name): MS. JUSTINE LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 COLUMBIA AVE # 200
LOS ANGELES CA
90017-1209
US

IV. Provider business mailing address

515 COLUMBIA AVE # 200
LOS ANGELES CA
90017-1209
US

V. Phone/Fax

Practice location:
  • Phone: 213-249-9388
  • Fax: 213-389-7993
Mailing address:
  • Phone: 213-249-9388
  • Fax: 213-389-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: