Healthcare Provider Details

I. General information

NPI: 1760126395
Provider Name (Legal Business Name): LEILA BOZORGNIA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23530 HAWTHORNE BLVD STE 260
TORRANCE CA
90505-4726
US

IV. Provider business mailing address

28431 GOLDEN MEADOW DR
RANCHO PALOS VERDES CA
90275-2925
US

V. Phone/Fax

Practice location:
  • Phone: 424-322-9866
  • Fax: 310-388-1104
Mailing address:
  • Phone: 310-994-9659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LEILA BOZORGNIA
Title or Position: PRESIDENT
Credential: MD
Phone: 424-277-2020