MEDICARE: DR. LEILA NICOLE MANSHADI DDS

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	122300000X	Dentist	DDS102599	CA

General Provider Information

NPI Number	:	1366928285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEILA NICOLE MANSHADI DDS

Provider Business Mailing Address
First Line	:	18752 VIA SAN MARCO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92603-3436
Country	:	US
Telephone Number	:	949-293-5234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E WORKMAN AVE STE A
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-6626
Country	:	US
Telephone Number	:	626-634-3393
Fax Number	:

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

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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