Provider Demographics
NPI:1790077030
Name:LE-TA, BICH-LIEN GIGI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BICH-LIEN
Middle Name:GIGI
Last Name:LE-TA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GIGI
Other - Middle Name:
Other - Last Name:LE-TA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:22676 WHITE OAKS
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4706
Mailing Address - Country:US
Mailing Address - Phone:194-958-6222
Mailing Address - Fax:
Practice Address - Street 1:7 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2302
Practice Address - Country:US
Practice Address - Phone:194-992-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436771835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist