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General NPI Number Information
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NPI Number | 1114952876
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Entity Type | Individual
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Provider Name | LEOR MATALON M.D
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 440 S MELROSE DR STE 201
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City | VISTA
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State | CA
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Zip | 92081-6666
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Country | US
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Telephone | 760-452-5150
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Fax | 858-764-2820
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Provider Business Mailing Address
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Address Line | 8070 LA JOLLA SHORES DR 265
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City | LA JOLLA
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State | CA
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Zip | 92037-3230
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Country | US
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Telephone | 760-826-2120
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Fax | 858-764-2820
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A62950
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License Number State | CA
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