Healthcare Provider Details

I. General information

NPI: 1740551977
Provider Name (Legal Business Name): LEONARD PALMER DOOTSON III R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W 7TH ST
LOS ANGELES CA
90017-2577
US

IV. Provider business mailing address

27162 9TH ST
HIGHLAND CA
92346-3651
US

V. Phone/Fax

Practice location:
  • Phone: 213-694-1250
  • Fax:
Mailing address:
  • Phone: 909-862-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number811648
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number811648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: