1194832642 NPI number — DR. LOREN A LESHAN M.D.

Table of content: DR. LOREN A LESHAN M.D. (NPI 1194832642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194832642 NPI number — DR. LOREN A LESHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LESHAN
Provider First Name:
LOREN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194832642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91346-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-837-5559
Provider Business Mailing Address Fax Number:
818-792-4793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19950 RINALDI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTER RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91326-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-403-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006

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: 207Q00000X , with the licence number:  25641 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME98855 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: G86992 , 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)

  • Identifier: 50655 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0007427-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00760798 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K1951A . This is a "BPC MEDICARE GROUP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".