Provider Demographics
NPI:1073665113
Name:WESTON, LEONARD JOSEPH (PH D)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JOSEPH
Last Name:WESTON
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:LEONARD
Other - Middle Name:JOSEPH
Other - Last Name:PUNG
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:72 810 AMBROSIA STREET
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-5971
Mailing Address - Country:US
Mailing Address - Phone:760-880-2002
Mailing Address - Fax:760-341-1333
Practice Address - Street 1:42525 RANCHO MIRAGE LANE
Practice Address - Street 2:5682 THE HISTORIC PLAZA
Practice Address - City:29 PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-1743
Practice Address - Country:US
Practice Address - Phone:760-367-0411
Practice Address - Fax:760-341-1333
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL57890Medicare ID - Type Unspecified