Healthcare Provider Details

I. General information

NPI: 1417208224
Provider Name (Legal Business Name): DAVID LEOS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ADMINISTRATION CIRCLE BLDG 1403 STOP1311
CHINA LAKE CA
93555
US

IV. Provider business mailing address

ADULT MEDICAL CARE CLINIC 1546 6TH STREET
TWENTYNINE PALMS CA
92277
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-3697
  • Fax:
Mailing address:
  • Phone: 760-830-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: