Provider Demographics
NPI:1003345737
Name:LE, STEPHANIE T (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 C ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3367
Mailing Address - Country:US
Mailing Address - Phone:916-734-6111
Mailing Address - Fax:916-731-7183
Practice Address - Street 1:3301 C ST STE 1400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3367
Practice Address - Country:US
Practice Address - Phone:916-734-6111
Practice Address - Fax:916-731-7183
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT213923207R00000X
CAMT213923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine