Healthcare Provider Details

I. General information

NPI: 1215948740
Provider Name (Legal Business Name): LEAH M PIKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 KATELLA AVE 303
LOS ALAMITOS CA
90720-3102
US

IV. Provider business mailing address

5357 E THE TOLEDO UNIT A
LONG BEACH CA
90803-7222
US

V. Phone/Fax

Practice location:
  • Phone: 562-936-9200
  • Fax: 562-936-9201
Mailing address:
  • Phone: 562-936-9200
  • Fax: 562-936-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberG83814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: