Individual
LEO INDIANER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16260 VENTURA BLVD, #515, ENCINO, CA 91436
(818) 788-5216
(818) 788-2702
Mailing address
16260 VENTURA BLVD, #515, ENCINO, CA 91436
(818) 788-5216
(818) 788-2702
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C25642
CA
207ND0900X
Dermatopathology Physician
C25642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ59180Z
—
CA
Enumeration date
10/11/2006
Last updated
02/28/2014
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