MEDICARE: MINH-THU THI LE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PSY 15571	CA

General Provider Information

NPI Number	:	1073542791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH-THU THI LE PH.D.

Provider Business Mailing Address
First Line	:	16787 BEACH BLVD
Second Line	:	#711
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4848
Country	:	US
Telephone Number	:	310-869-1050
Fax Number	:	714-379-0187

Provider Business Practice Location Address
First Line	:	3415 S SEPULVEDA BLVD
Second Line	:	FL 11
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-6060
Country	:	US
Telephone Number	:	310-869-1050
Fax Number	:	714-379-0187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	05/28/2020

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