Provider Demographics
NPI:1073160958
Name:GETZ, LEAH RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RENEE
Last Name:GETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:GETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:23645 ALGIERS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16100 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3716
Practice Address - Country:US
Practice Address - Phone:949-393-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
CAPA60465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program