Provider Demographics
NPI:1417643792
Name:LE, MICHELLE NGUYEN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NGUYEN
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 1:1102 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-7161
Mailing Address - Country:US
Mailing Address - Phone:210-233-7000
Mailing Address - Fax:
Practice Address - Street 1:1102 BARCLAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7161
Practice Address - Country:US
Practice Address - Phone:210-233-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program