Healthcare Provider Details

I. General information

NPI: 1982838736
Provider Name (Legal Business Name): LEAH ANNE BURNETT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LINDEN AVE
LONG BEACH CA
90813-3321
US

IV. Provider business mailing address

PO BOX 661360
ARCADIA CA
91066-1360
US

V. Phone/Fax

Practice location:
  • Phone: 562-491-9000
  • Fax: 562-491-7986
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: