Healthcare Provider Details

I. General information

NPI: 1588026934
Provider Name (Legal Business Name): ALEXANDER LEASURE M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PESETAS LN
SANTA BARBARA CA
93110
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-6110
  • Fax:
Mailing address:
  • Phone: 805-681-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA158356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: