Provider Demographics
NPI:1518365253
Name:LE, VIVIAN (PA)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1720 N CENTRAL EXPY STE 150
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3100
Mailing Address - Country:US
Mailing Address - Phone:972-542-2800
Mailing Address - Fax:
Practice Address - Street 1:1720 N CENTRAL EXPY STE 150
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3100
Practice Address - Country:US
Practice Address - Phone:972-542-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant