MEDICARE: TRAM BAO LE MD

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	207Q00000X	Family Medicine Physician	A105829	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1346442985	OTHER	CA	1346442985

General Provider Information

NPI Number	:	1346442985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAM BAO LE MD

Provider Business Mailing Address
First Line	:	5507 EL CAJON BLVD
Second Line	:	L
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-286-2789
Fax Number	:	619-265-2070

Provider Business Practice Location Address
First Line	:	5507 EL CAJON BLVD
Second Line	:	L
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-3624
Country	:	US
Telephone Number	:	619-286-2789
Fax Number	:	619-265-2070

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	02/17/2016

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