Individual
MS. LEEDA MERIN MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
200 MULLINS DR, LEBANON, OR 97355-3983
(541) 259-0258
Mailing address
11474 JACOBSEN RD, BEAUMONT, CA 92223-6241
(503) 593-1160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20A17822
CA
Other
Enumeration date
04/19/2016
Last updated
09/10/2021
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