Healthcare Provider Details

I. General information

NPI: 1679747778
Provider Name (Legal Business Name): LEANNA LYN HUARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 12-475 MDCC
LOS ANGELES CA
90095-2804
US

IV. Provider business mailing address

10833 LE CONTE AVE 12-475 MDCC
LOS ANGELES CA
90095-2804
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6752
  • Fax:
Mailing address:
  • Phone: 310-825-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA110788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: