Provider Demographics
NPI:1588803696
Name:LE, VUONG (BCBA)
Entity Type:Individual
Prefix:
First Name:VUONG
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:2535 KETTNER BLVD STE 1C1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1268
Mailing Address - Country:US
Mailing Address - Phone:619-269-6057
Mailing Address - Fax:619-269-6387
Practice Address - Street 1:2535 KETTNER BLVD STE 1C1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1268
Practice Address - Country:US
Practice Address - Phone:619-269-6057
Practice Address - Fax:619-269-6387
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3412103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003073156OtherAEFCT COMPANY NPI#
26-0717497OtherFEDERAL TAX ID NUMBER (EIN)