Healthcare Provider Details

I. General information

NPI: 1548308109
Provider Name (Legal Business Name): NGUYEN L LE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5507 EL CAJON BLVD # B
SAN DIEGO CA
92115-3624
US

IV. Provider business mailing address

5507 EL CAJON BLVD # B
SAN DIEGO CA
92115-3624
US

V. Phone/Fax

Practice location:
  • Phone: 619-582-8814
  • Fax:
Mailing address:
  • Phone: 619-582-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA833090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: