Healthcare Provider Details

I. General information

NPI: 1386172419
Provider Name (Legal Business Name): LEILA SHEIKHOLESLAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEILA SHEIKH DO

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 03/07/2023
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 OCEAN PARK BLVD STE 130
SANTA MONICA CA
90405-5244
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-450-1200
  • Fax: 310-450-8830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: