Provider Demographics
NPI:1225494644
Name:LE, PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4849 VAN NUYS BLVD
Mailing Address - Street 2:#102
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2110
Mailing Address - Country:US
Mailing Address - Phone:818-377-7777
Mailing Address - Fax:818-788-7906
Practice Address - Street 1:4849 VAN NUYS BLVD
Practice Address - Street 2:#102
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2110
Practice Address - Country:US
Practice Address - Phone:818-377-7777
Practice Address - Fax:818-788-7906
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant