Provider Demographics
NPI:1881646834
Name:LEETE, TRANG NGOC
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:NGOC
Last Name:LEETE
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 1:17612 BEACH BLVD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6820
Mailing Address - Country:US
Mailing Address - Phone:714-369-0932
Mailing Address - Fax:
Practice Address - Street 1:17612 BEACH BLVD
Practice Address - Street 2:SUITE 19
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6873
Practice Address - Country:US
Practice Address - Phone:714-369-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881646834Medicare PIN