Healthcare Provider Details

I. General information

NPI: 1982945077
Provider Name (Legal Business Name): LEON D MEZENTSEV PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ARBOR DR UNIT 103
SAN DIEGO CA
92103-7432
US

IV. Provider business mailing address

521 ARBOR DR UNIT 103
SAN DIEGO CA
92103-7432
US

V. Phone/Fax

Practice location:
  • Phone: 619-300-6947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH67178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: