1326138355 NPI number — DR. SCOTT HOWARD LEIBOLD D.P.M

Table of content: DR. SCOTT HOWARD LEIBOLD D.P.M (NPI 1326138355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326138355 NPI number — DR. SCOTT HOWARD LEIBOLD D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIBOLD
Provider First Name:
SCOTT
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEIBOLD
Provider Other First Name:
SCOTT
Provider Other Middle Name:
HOWARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326138355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 RISING HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91766-4918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-217-7824
Provider Business Mailing Address Fax Number:
818-924-4217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 RISING HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91766-4918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-217-7824
Provider Business Practice Location Address Fax Number:
818-924-4217
Provider Enumeration Date:
10/13/2006

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: 213EP1101X , with the licence number:  E4073 , 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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