MEDICARE: JAMES D. LEO, M.D., INC.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1407989247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES D. LEO, M.D., INC.

Provider Business Mailing Address
First Line	:	2650 ELM AVE STE 307
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-426-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 ELM AVE STE 307
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1600
Country	:	US
Telephone Number	:	562-426-6220
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATHIE RIDGEWAY
Credential	:
Telephone Number	:	562-426-6220

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/08/2019

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