Healthcare Provider Details

I. General information

NPI: 1114118023
Provider Name (Legal Business Name): LEITA J HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEITA J SADLER

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 FULLERTON AVE STE 203
CORONA CA
92881-3109
US

IV. Provider business mailing address

1810 FULLERTON AVE STE 203
CORONA CA
92881-3109
US

V. Phone/Fax

Practice location:
  • Phone: 844-845-8737
  • Fax: 855-300-6748
Mailing address:
  • Phone: 844-845-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG064281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: