Healthcare Provider Details

I. General information

NPI: 1376765883
Provider Name (Legal Business Name): DIRECT ACCESS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD. SUITE 604
ENCINO AL
91436
US

IV. Provider business mailing address

16661 VENTURA BLVD. SUITE 604
ENCINO AL
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-8213
  • Fax: 818-788-8343
Mailing address:
  • Phone: 818-788-8213
  • Fax: 818-788-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN LEONI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-788-8213