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General NPI Number Information
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NPI Number | 1184631954
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Entity Type | Individual
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Provider Name | PHA C LE D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 1260 MAGNOLIA AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4902
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Country | US
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Telephone | 714-566-5235
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 MAGNOLIA AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4902
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Country | US
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Telephone | 714-566-5235
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036115367
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A9993
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License Number State | CA
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