=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891934048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEON OZERAN PSY.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2009
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 W 3RD ST 2ND FLOOR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-994-2116
-----------------------------------------------------
Fax | 818-781-5378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14621 TITUS ST SUITE # 129
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-994-2116
-----------------------------------------------------
Fax | 818-781-5378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY19571
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------