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General NPI Number Information
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NPI Number | 1316255680
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Entity Type | Organization
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Legal Business Name | LESLIE A BAIN MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 1441 AVOCADO AVE SUITE 706
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-720-9170
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Fax | 949-720-0755
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Provider Business Mailing Address
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Address Line | 1441 AVOCADO AVE SUITE 706
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7721
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Country | US
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Telephone | 949-720-9170
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Fax | 949-720-0755
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LESLIE BAIN
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Credential | MD
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Telephone | 949-720-9170
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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 | A24274
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License Number State | CA
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