Healthcare Provider Details

I. General information

NPI: 1255365722
Provider Name (Legal Business Name): LEENA S SHETH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E HOLT AVE STE 10
POMONA CA
91767-5835
US

IV. Provider business mailing address

1460 E HOLT AVE STE 10
POMONA CA
91767-5835
US

V. Phone/Fax

Practice location:
  • Phone: 909-980-3537
  • Fax: 909-484-5282
Mailing address:
  • Phone: 909-980-3537
  • Fax: 909-484-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA46030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: