Provider Demographics
NPI:1407122005
Name:LE, STEPHANIE THU
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:THU
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 43RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1510
Mailing Address - Country:US
Mailing Address - Phone:619-284-3937
Mailing Address - Fax:619-284-3938
Practice Address - Street 1:4029 43RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1510
Practice Address - Country:US
Practice Address - Phone:619-284-3937
Practice Address - Fax:619-284-3938
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGQ973ZMedicare UPIN