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General NPI Number Information
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NPI Number | 1093891061
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Entity Type | Individual
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Provider Name | TIFFANY LE
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 700 W 19TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3517
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Country | US
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Telephone | 949-645-9334
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Fax | 949-645-9378
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Provider Business Mailing Address
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Address Line | 20001 N NEW BRITAIN LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-4422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 17563
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License Number State | CA
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