Provider Demographics
NPI:1225509185
Name:LE, VIVIAN (RN BSN)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:TUONG-VI
Other - Middle Name:VUONG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13553 POWAY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-7007
Mailing Address - Country:US
Mailing Address - Phone:858-610-8469
Mailing Address - Fax:
Practice Address - Street 1:13553 POWAY CREEK RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-7007
Practice Address - Country:US
Practice Address - Phone:858-610-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95171060163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice