Healthcare Provider Details

I. General information

NPI: 1578873428
Provider Name (Legal Business Name): LEILA MARIAM YOONESSI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ALAMITOS AVE
LONG BEACH CA
90813-4726
US

IV. Provider business mailing address

26572 ACADEMY DR
PALOS VERDES ESTATES CA
90274-3968
US

V. Phone/Fax

Practice location:
  • Phone: 562-489-7405
  • Fax: 562-489-7406
Mailing address:
  • Phone: 310-729-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA114034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA114034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: