Healthcare Provider Details

I. General information

NPI: 1770132375
Provider Name (Legal Business Name): LESLIE IRVINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROSECRANS AVE STE 110
MANHATTAN BEACH CA
90266-2470
US

IV. Provider business mailing address

1200 ROSECRANS AVE STE 110
MANHATTAN BEACH CA
90266-2470
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1280
  • Fax:
Mailing address:
  • Phone: 424-225-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE E IRVINE
Title or Position: PRESIDENT
Credential: MD
Phone: 424-225-1280