MEDICARE: LELAND RUSSELL SOIEFER MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	A193131	CA

General Provider Information

NPI Number	:	1932603248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LELAND RUSSELL SOIEFER MD

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:	212-746-8051

Provider Business Practice Location Address
First Line	:	2391 ISLAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2941
Country	:	US
Telephone Number	:	619-515-2435
Fax Number	:

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

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	07/01/2024

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