Provider Demographics
NPI:1457085409
Name:LE, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LE
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 1:11588 VIA RANCHO SAN DIEGO
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-5277
Mailing Address - Country:US
Mailing Address - Phone:858-358-3599
Mailing Address - Fax:619-599-8436
Practice Address - Street 1:11588 VIA RANCHO SAN DIEGO
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-5277
Practice Address - Country:US
Practice Address - Phone:858-358-3599
Practice Address - Fax:619-599-8436
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist