Healthcare Provider Details

I. General information

NPI: 1528808318
Provider Name (Legal Business Name): LEILA ZIAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD. BUILDING 402, MAIL CODE 10H5
LOS ANGELES CA
90073
US

IV. Provider business mailing address

12042 VERANO CT
SAN DIEGO CA
92128-1233
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 310-683-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95028085
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95356663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: