MEDICARE: LE DIEP

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	183500000X	Pharmacist	70440	CA

General Provider Information

NPI Number	:	1124433321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LE DIEP

Provider Business Mailing Address
First Line	:	2692 SOMERSET PARK CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2271
Country	:	US
Telephone Number	:	408-858-7304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 SOMERSET PARK CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2271
Country	:	US
Telephone Number	:	408-858-7304
Fax Number	:

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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Directions to “ LE DIEP ” Practice Location

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