MEDICARE: CECILIA CAMPBELL 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
1	174400000X	Specialist	9910	CA

General Provider Information

NPI Number	:	1477395325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA CAMPBELL LE

Provider Business Mailing Address
First Line	:	1434 EL PRADO AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-3205
Country	:	US
Telephone Number	:	310-991-6095
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 SARTORI AVE STE 202
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2756
Country	:	US
Telephone Number	:	424-306-9306
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ CECILIA CAMPBELL LE” Practice Location

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