Healthcare Provider Details

I. General information

NPI: 1639248875
Provider Name (Legal Business Name): DR. LEON C HSU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36320 INLAND VALLEY DR SUITE 208
WILDOMAR CA
92595-9547
US

IV. Provider business mailing address

39426 VIA MONSERATE
MURRIETA CA
42563-5562
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-8482
  • Fax: 951-698-7122
Mailing address:
  • Phone: 951-677-6242
  • Fax: 951-698-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: