Healthcare Provider Details

I. General information

NPI: 1538242763
Provider Name (Legal Business Name): GIA D LE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 E AMAR RD STE F
WEST COVINA CA
91792-1619
US

IV. Provider business mailing address

17150 NEWHOPE ST STE 507
FOUNTAIN VALLEY CA
92708-4250
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-9100
  • Fax:
Mailing address:
  • Phone: 714-437-7400
  • Fax: 714-437-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA32938
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA32938
License Number StateCA

VIII. Authorized Official

Name: GIA D. LE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-839-9100