Healthcare Provider Details

I. General information

NPI: 1285910232
Provider Name (Legal Business Name): MS. LEAH DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

IV. Provider business mailing address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax: 310-396-6974
Mailing address:
  • Phone: 310-314-6200
  • Fax: 310-396-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: