=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740551977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD PALMER DOOTSON III R.N.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2012
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 W 7TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-2577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-694-1250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27162 9TH ST
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92346-3651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-862-1335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 811648
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 811648
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------