Healthcare Provider Details

I. General information

NPI: 1194808980
Provider Name (Legal Business Name): LEANDRO GULAPA GATUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N LARCHMONT BLVD
LOS ANGELES CA
90004-1305
US

IV. Provider business mailing address

531 N LARCHMONT BLVD
LOS ANGELES CA
90004-1305
US

V. Phone/Fax

Practice location:
  • Phone: 323-462-7574
  • Fax:
Mailing address:
  • Phone: 323-462-7574
  • Fax: 323-462-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA45231
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA45231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: