Provider Demographics
NPI:1891541066
Name:LE, ETHAN (PA-C)
Entity type:Individual
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First Name:ETHAN
Middle Name:
Last Name:LE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:714 S HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2337
Mailing Address - Country:US
Mailing Address - Phone:714-714-0016
Mailing Address - Fax:714-486-3744
Practice Address - Street 1:714 S HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2337
Practice Address - Country:US
Practice Address - Phone:714-714-0016
Practice Address - Fax:714-486-3744
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2025-01-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant