Healthcare Provider Details

I. General information

NPI: 1811013766
Provider Name (Legal Business Name): LEON ROVNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE SUITE 800
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

PO BOX 480029
LOS ANGELES CA
90048-1029
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-1414
  • Fax: 213-749-4021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57011254
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA115138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: