Healthcare Provider Details

I. General information

NPI: 1093094161
Provider Name (Legal Business Name): GRACE THUY LE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE THUY NP

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

PO BOX 5280 PBS
SAN JOSE CA
95150-5280
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNP19237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: