Healthcare Provider Details

I. General information

NPI: 1588362669
Provider Name (Legal Business Name): LEADWEST MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MAGNOLIA AVE STE 103
CORONA CA
92879-3124
US

IV. Provider business mailing address

2549 EASTBLUFF DR STE B781
NEWPORT BEACH CA
92660-3500
US

V. Phone/Fax

Practice location:
  • Phone: 714-584-8824
  • Fax:
Mailing address:
  • Phone: 714-584-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJAT AURORA
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 925-984-4184