Healthcare Provider Details

I. General information

NPI: 1790863686
Provider Name (Legal Business Name): LEILA YASREBI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 BARRANCA PKWY STE 300
IRVINE CA
92604-4709
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 200B
NEWPORT BEACH CA
92663-3663
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3102
  • Fax: 949-791-3113
Mailing address:
  • Phone: 949-791-3001
  • Fax: 949-791-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: