Healthcare Provider Details

I. General information

NPI: 1407142243
Provider Name (Legal Business Name): CURTIS W. LEONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10992 SAN DIEGO MISSION RD
SAN DIEGO CA
92108-2444
US

IV. Provider business mailing address

10992 SAN DIEGO MISSION RD
SAN DIEGO CA
92108-2444
US

V. Phone/Fax

Practice location:
  • Phone: 619-641-4324
  • Fax: 619-647-4325
Mailing address:
  • Phone: 619-641-4324
  • Fax: 619-647-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA124565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: