Healthcare Provider Details

I. General information

NPI: 1407989247
Provider Name (Legal Business Name): JAMES D. LEO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 ELM AVE STE 307
LONG BEACH CA
90806-1600
US

IV. Provider business mailing address

2650 ELM AVE STE 307
LONG BEACH CA
90806-1600
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-6220
  • Fax:
Mailing address:
  • Phone: 562-426-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHIE RIDGEWAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-426-6220