1073665113 NPI number — DR. LEONARD JOSEPH WESTON PH D

Table of content: DR. LEONARD JOSEPH WESTON PH D (NPI 1073665113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073665113 NPI number — DR. LEONARD JOSEPH WESTON PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTON
Provider First Name:
LEONARD
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PUNG
Provider Other First Name:
LEONARD
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
PH D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073665113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 810 AMBROSIA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM DESERT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92260-5971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-880-2002
Provider Business Mailing Address Fax Number:
760-341-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42525 RANCHO MIRAGE LANE
Provider Second Line Business Practice Location Address:
5682 THE HISTORIC PLAZA
Provider Business Practice Location Address City Name:
29 PALMS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92277-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-367-0411
Provider Business Practice Location Address Fax Number:
760-341-1333
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY 5789 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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