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General NPI Number Information
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NPI Number | 1801953237
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Entity Type | Organization
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Legal Business Name | FREDERIC J LEONG MD INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 555 MARIN ST. SUITE #220
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City | THOUSAND OAKS
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State | CA
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Zip | 91360
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Country | US
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Telephone | 805-497-7214
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Fax | 805-497-0864
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Provider Business Mailing Address
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Address Line | 555 MARIN ST #220
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-4236
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Country | US
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Telephone | 805-497-7214
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Fax | 805-497-0864
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Authorized Official
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Title or Position | OFFICE MGR
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Name | MS. PATRICIA ANN WAITE
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Credential |
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Telephone | 805-497-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | G71490
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License Number State | CA
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