Individual
DR. MIMI QUYEN THAI THUC LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10800 MAGNOLIA AVE, RIVERSIDE, CA 92505-3043
(866) 984-7483
(951) 353-5073
Mailing address
10800 MAGNOLIA AVE, RIVERSIDE, CA 92505-3043
(866) 984-7483
(951) 353-5073
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A88869
CA
207RI0011X
Interventional Cardiology Physician
A88869
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A888690
—
CA
Enumeration date
05/16/2006
Last updated
12/13/2021
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