Healthcare Provider Details

I. General information

NPI: 1912264722
Provider Name (Legal Business Name): LEILA BOZORGNIA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 S SEPULVEDA BLVD STE 202
LOS ANGELES CA
90064-3973
US

IV. Provider business mailing address

2990 S SEPULVEDA BLVD STE 202
LOS ANGELES CA
90064-3973
US

V. Phone/Fax

Practice location:
  • Phone: 424-227-2020
  • Fax: 310-388-1104
Mailing address:
  • Phone: 424-277-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA107098
License Number StateCA

VIII. Authorized Official

Name: DR. LEILA BOZORGNIA
Title or Position: PRESIDENT
Credential: MD
Phone: 424-277-2020