MEDICARE: DR. LEELA ATHALYE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	20A11943	CA

General Provider Information

NPI Number	:	1093097818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEELA ATHALYE D.O.

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7853
Country	:	US
Telephone Number	:	499-720-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 501
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7831
Country	:	US
Telephone Number	:	949-720-1170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	06/06/2025

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