Provider Demographics
NPI:1053331710
Name:PEREZ, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8106
Mailing Address - Country:US
Mailing Address - Phone:661-322-3700
Mailing Address - Fax:
Practice Address - Street 1:2005 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-322-6700
Practice Address - Fax:661-322-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG521120207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G521120Medicaid
CAA52169Medicare UPIN
CA00G521120Medicaid