MEDICARE: VIVIAN 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	183500000X	Pharmacist	P9544	ID
2	390200000X	Student in an Organized Health Care Education/Training Program	42910	CA

General Provider Information

NPI Number	:	1902389356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN LE

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1098
Country	:	US
Telephone Number	:	619-532-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-2638
Country	:	US
Telephone Number	:	619-532-6400
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	10/21/2021

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Directions to “ VIVIAN LE ” Practice Location

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