Healthcare Provider Details

I. General information

NPI: 1376832402
Provider Name (Legal Business Name): IRENE P LEECH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 ELM AVE STE 307
LONG BEACH CA
90813-3267
US

IV. Provider business mailing address

1040 ELM AVE STE 307
LONG BEACH CA
90813-3267
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-8500
  • Fax: 562-435-8477
Mailing address:
  • Phone: 562-590-8500
  • Fax: 562-435-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG41993
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG41993
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberG41993
License Number StateCA

VIII. Authorized Official

Name: DR. IRENE PATRICIA LEECH
Title or Position: PRESIDENT
Credential: MD
Phone: 562-590-8500