Healthcare Provider Details

I. General information

NPI: 1639527286
Provider Name (Legal Business Name): LEAH MARIE HUMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH MARIE BATES ALBERS N/A

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24785 STEWART ST STE 111
LOMA LINDA CA
92350-1721
US

IV. Provider business mailing address

24785 STEWART ST STE 111
LOMA LINDA CA
92350-1721
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4920
  • Fax:
Mailing address:
  • Phone: 909-558-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberA156292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: