Healthcare Provider Details

I. General information

NPI: 1326789652
Provider Name (Legal Business Name): MR. ANDREW LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 MERIDIAN AVE STE 30
SAN JOSE CA
95120-2700
US

IV. Provider business mailing address

6055 MERIDIAN AVE STE 30
SAN JOSE CA
95120-2700
US

V. Phone/Fax

Practice location:
  • Phone: 408-755-6237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: