Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | A88869 | CA |
N | 207RI0011X | Interventional Cardiology | A88869 | CA |
NPI | 1124070420 |
---|---|
Provider Name | Dr. Mimi Quyen Thai Thuc Le |
First Address | Riverside, CA 92505-3043 |
Second Address | Riverside, CA 92505-3043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A888690 | (05) | CA |
I35963 | (02) | CA |