Provider Demographics
NPI:1932510799
Name:LE, HENRY (PA-C)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:HIEN
Other - Middle Name:DINH
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9671 AMADOR RANCH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1949
Mailing Address - Country:US
Mailing Address - Phone:714-725-0585
Mailing Address - Fax:
Practice Address - Street 1:9671 AMADOR RANCH AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1949
Practice Address - Country:US
Practice Address - Phone:714-725-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant