Organization
FREDERIC J LEONG MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICIA ANN WAITE (OFFICE MGR)
(805) 497-7214
Entity
Organization
Contact information
Practice address
555 MARIN ST., SUITE #220, THOUSAND OAKS, CA 91360
(805) 497-7214
(805) 497-0864
Mailing address
555 MARIN ST, #220, THOUSAND OAKS, CA 91360-4236
(805) 497-7214
(805) 497-0864
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
G71490
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G714901
—
CA
Enumeration date
01/03/2007
Last updated
01/12/2011
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