Healthcare Provider Details

I. General information

NPI: 1982193827
Provider Name (Legal Business Name): NGOC TRAM NGUYEN LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 AERO DR STE 330
SAN DIEGO CA
92123-1763
US

IV. Provider business mailing address

5348 UNIVERSITY AVE STE 108
SAN DIEGO CA
92105-8025
US

V. Phone/Fax

Practice location:
  • Phone: 619-540-4693
  • Fax:
Mailing address:
  • Phone: 619-540-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: