Provider Demographics
NPI:1972237915
Name:HOANG LE, MARIE L (AGNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:HOANG LE
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2042
Mailing Address - Country:US
Mailing Address - Phone:714-224-6698
Mailing Address - Fax:
Practice Address - Street 1:16027 BROOKHURST ST STE I-741
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1551
Practice Address - Country:US
Practice Address - Phone:714-224-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020053163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology