Provider Demographics
NPI:1619305588
Name:LE, JULIANA NGAN HA (OD)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:NGAN HA
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:LE
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2325 MADRUGADA DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1370
Mailing Address - Country:US
Mailing Address - Phone:909-263-1177
Mailing Address - Fax:
Practice Address - Street 1:2325 MADRUGADA DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1370
Practice Address - Country:US
Practice Address - Phone:909-263-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60391163152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist