1417397159 NPI number — DR. LEON PATRICK WEATHERSBY JR. D.C.

Table of content: DR. LEON PATRICK WEATHERSBY JR. D.C. (NPI 1417397159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417397159 NPI number — DR. LEON PATRICK WEATHERSBY JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHERSBY
Provider First Name:
LEON
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEATHERSBY
Provider Other First Name:
LEON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417397159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8255 VINEYARD AVE
Provider Second Line Business Mailing Address:
1100H
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-3375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-838-1600
Provider Business Mailing Address Fax Number:
310-453-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9225 VENICE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-838-1600
Provider Business Practice Location Address Fax Number:
310-453-1363
Provider Enumeration Date:
06/26/2013

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: 111N00000X , with the licence number:  22887 , 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)