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General NPI Number Information
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NPI Number | 1194940015
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Entity Type | Organization
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Legal Business Name | LEPORT SURGICAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 18111 BROOKHURST ST SUITE 5600
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6728
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Country | US
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Telephone | 714-861-4666
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Fax | 714-916-5534
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Provider Business Mailing Address
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Address Line | 18111 BROOKHURST ST SUITE 5600
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6728
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Country | US
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Telephone | 714-861-4666
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Fax | 714-861-4682
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | PETER CARY LEPORT
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Credential | MD
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Telephone | 714-861-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G47193
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License Number State | CA
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