Provider Demographics
NPI:1992386312
Name:LE, TIFFANY (PA)
Entity type:Individual
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First Name:TIFFANY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:14642 NEWPORT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6059
Mailing Address - Country:US
Mailing Address - Phone:714-247-0300
Mailing Address - Fax:714-259-1369
Practice Address - Street 1:14642 NEWPORT AVE STE 200
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6058
Practice Address - Country:US
Practice Address - Phone:714-247-0300
Practice Address - Fax:714-259-1598
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2022-05-09
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Provider Licenses
StateLicense IDTaxonomies
CA59103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant