Healthcare Provider Details

I. General information

NPI: 1639185838
Provider Name (Legal Business Name): LEONARD A FARBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 N HARBOR BLVD STE 1500
FULLERTON CA
92835-3823
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5632
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number210306
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC153081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: