Individual
LEONID PRAVOVEROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7373 WEST LN, STOCKTON, CA 95210-3377
(209) 476-2000
Mailing address
1800 HARRISON ST FL 7, OAKLAND, CA 94612-3466
(510) 625-6262
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A77583
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A775830
—
CA
Enumeration date
11/01/2006
Last updated
12/08/2021
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