Provider Demographics
NPI:1972384394
Name:LE, JENNIFER THI (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 L ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1066
Mailing Address - Country:US
Mailing Address - Phone:619-271-7100
Mailing Address - Fax:
Practice Address - Street 1:111 ELM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2692
Practice Address - Country:US
Practice Address - Phone:619-677-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care