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General NPI Number Information
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NPI Number | 1447046800
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Entity Type | Organization
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Legal Business Name | BIG LEAP MEDICAL GROUP OF CALIFORNIA P.C.
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 22281 AMBER ROSE
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City | MISSION VIEJO
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State | CA
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Zip | 92692-4522
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Country | US
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Telephone | 415-792-0195
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Fax |
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Provider Business Mailing Address
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Address Line | 2261 MARKET ST STE 10836
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1612
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUMEET VADERA
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Credential | MD
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Telephone | 415-792-0195
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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