MEDICARE: MR. LEON OZERAN PSY.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	103TC0700X	Clinical Psychologist	PSY19571	CA

General Provider Information

NPI Number	:	1891934048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEON OZERAN PSY.D

Provider Business Mailing Address
First Line	:	14621 TITUS ST
Second Line	:	SUITE # 129
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4905
Country	:	US
Telephone Number	:	818-994-2116
Fax Number	:	818-781-5378

Provider Business Practice Location Address
First Line	:	1230 W 3RD ST
Second Line	:	2ND FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1408
Country	:	US
Telephone Number	:	818-994-2116
Fax Number	:	818-781-5378

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

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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