Healthcare Provider Details

I. General information

NPI: 1265721112
Provider Name (Legal Business Name): DR. PETER H. LEOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 201
FOOTHILL RANCH CA
92610-2842
US

IV. Provider business mailing address

26730 TOWNE CENTRE DR STE 201
FOOTHILL RANCH CA
92610-2842
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-5888
  • Fax: 949-916-5889
Mailing address:
  • Phone: 949-916-5888
  • Fax: 949-916-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: