Healthcare Provider Details

I. General information

NPI: 1316389729
Provider Name (Legal Business Name): LORENA LEITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

IV. Provider business mailing address

747 52ND ST ROOM 245
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA138285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: