Healthcare Provider Details

I. General information

NPI: 1982722187
Provider Name (Legal Business Name): OSCAR I. LEAL MD A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N. LA CIENEGA BLVD, SUITE 106
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

99 N. LA CIENEGA BLVD, SUITE 106
BEVERLY HILLS CA
90211
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-4000
  • Fax: 310-652-4020
Mailing address:
  • Phone: 310-652-4000
  • Fax: 310-652-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. GERALDINE LUSKER
Title or Position: BILLING MANAGER
Credential:
Phone: 949-275-8895