Provider Demographics
NPI:1467563759
Name:LE, MAISA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MAISA
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14372 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4578
Mailing Address - Country:US
Mailing Address - Phone:714-922-4100
Mailing Address - Fax:
Practice Address - Street 1:14372 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4578
Practice Address - Country:US
Practice Address - Phone:714-922-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15976363LF0000X
NY342743363LF0000X
CA579168163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY745506OtherREGISTERED NURSE LICENSE
NY342743OtherNURSE PRACTITIONER LICENSE
CA15976OtherFAMILY NURSE PRACTITIONER
CA579168OtherREGISTERED NURSE
CA63584OtherPUBLIC HEALTH NURSE