=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710311139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEPORT EDUCATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2013
-----------------------------------------------------
Last Update Date | 08/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18111 BROOKHURST ST SUITE 5600
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-6728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-912-9380
-----------------------------------------------------
Fax | 714-912-9381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18111 BROOKHURST ST SUITE 5600
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-6728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-912-9380
-----------------------------------------------------
Fax | 714-912-9381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. PETER C LEPORT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 714-912-9380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G47193
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------