Organization
LEON BACHOURA, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEON BACHOURA (PRESIDENT)
(909) 592-2078
Entity
Organization
Contact information
Practice address
1334 W COVINA BLVD, SUITE 201, SAN DIMAS, CA 91773-3211
(909) 592-2078
(909) 592-0279
Mailing address
1334 W COVINA BLVD, SUITE 201, SAN DIMAS, CA 91773-3211
(909) 592-2078
(909) 592-0279
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A36186
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A361860
—
CA
Enumeration date
11/22/2006
Last updated
08/22/2020
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