Healthcare Provider Details

I. General information

NPI: 1497980874
Provider Name (Legal Business Name): LEON R. PECK, A PROFESSIONAL CORPORATIONM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD SUITE815
BEVERLY HILLS CA
90211-3121
US

IV. Provider business mailing address

8500 WILSHIRE BLVD SUITE815
BEVERLY HILLS CA
90211-3121
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-6363
  • Fax: 310-652-5785
Mailing address:
  • Phone: 310-657-6363
  • Fax: 310-652-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEON ROBERT PECK
Title or Position: OWNER
Credential: DDS, PHD
Phone: 310-657-6363