Provider Demographics
NPI:1194735589
Name:LE, TUYET MAI (PA)
Entity type:Individual
Prefix:
First Name:TUYET
Middle Name:MAI
Last Name:LE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2158 OPAL RDG
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8814
Mailing Address - Country:US
Mailing Address - Phone:760-598-7496
Mailing Address - Fax:
Practice Address - Street 1:629 2ND ST
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3507
Practice Address - Country:US
Practice Address - Phone:760-753-7842
Practice Address - Fax:760-753-7259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS62824Medicare UPIN