Healthcare Provider Details

I. General information

NPI: 1205467073
Provider Name (Legal Business Name): CHARLES LE M.D. PEACE OF MIND ALLIANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 47TH ST
SAN DIEGO CA
92115-4516
US

IV. Provider business mailing address

4419 47TH ST
SAN DIEGO CA
92115-4516
US

V. Phone/Fax

Practice location:
  • Phone: 619-929-1605
  • Fax:
Mailing address:
  • Phone: 619-929-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES NGUYEN-THANH LE
Title or Position: PRESIDENT
Credential: MD
Phone: 619-929-1605