MEDICARE: DR. LESLIE M. DROZD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY10317	CA

General Provider Information

NPI Number	:	1659452365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE M. DROZD PH.D.

Provider Business Mailing Address
First Line	:	1001 DOVE ST
Second Line	:	SUITE 140
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2838
Country	:	US
Telephone Number	:	949-786-7263
Fax Number	:	949-851-1456

Provider Business Practice Location Address
First Line	:	1001 DOVE ST.
Second Line	:	SUITE 140
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2838
Country	:	US
Telephone Number	:	949-786-7263
Fax Number	:	949-851-1456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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