Healthcare Provider Details

I. General information

NPI: 1508225111
Provider Name (Legal Business Name): LEILA ASTARABADI LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 BRISTOL ST 2ND FLOOR
COSTA MESA CA
92626-8605
US

IV. Provider business mailing address

4676 SIERRA TREE LN
IRVINE CA
92612-2245
US

V. Phone/Fax

Practice location:
  • Phone: 714-424-9001
  • Fax:
Mailing address:
  • Phone: 917-273-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number68162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: