Provider Demographics
NPI:1013026251
Name:LERA, LELAND MARK (MA)
Entity Type:Individual
Prefix:MR
First Name:LELAND
Middle Name:MARK
Last Name:LERA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5018
Mailing Address - Country:US
Mailing Address - Phone:650-938-0100
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE # 126MPD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2634
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1704231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA3587OtherHEARING AID LICENS
CAAU1704OtherAUDIOLOGY LICENSE
CA09118665OtherASHA CERTIFICATION