Healthcare Provider Details

I. General information

NPI: 1447046800
Provider Name (Legal Business Name): BIG LEAP MEDICAL GROUP OF CALIFORNIA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22281 AMBER ROSE
MISSION VIEJO CA
92692-4522
US

IV. Provider business mailing address

2261 MARKET ST STE 10836
SAN FRANCISCO CA
94114-1612
US

V. Phone/Fax

Practice location:
  • Phone: 415-792-0195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMEET VADERA
Title or Position: OWNER
Credential: MD
Phone: 415-792-0195