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NPI Code Detail

MEDICARE: DAT LE

MEDICARE: DAT LE
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
1103K00000XBehavior Analyst1-18-31227CA

General Provider Information

NPI Number : 1356828263
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAT LE
Provider Business Mailing Address
First Line : 16782 VON KARMAN AVE STE 11
Second Line :
City : IRVINE
State : CA
Zip : 92606-2417
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 3431 CHERRY AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-4911
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2018
Last Update Date : 02/01/2021

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Directions to “ DAT LE ” Practice Location

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