Provider Demographics
NPI:1083632723
Name:HILBURG, LELAND EARL
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:EARL
Last Name:HILBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14807 HESBY ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1606
Mailing Address - Country:US
Mailing Address - Phone:818-990-4583
Mailing Address - Fax:818-990-4583
Practice Address - Street 1:14807 HESBY ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1606
Practice Address - Country:US
Practice Address - Phone:818-990-4583
Practice Address - Fax:818-990-4583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG3725207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G37250OtherBLUE SHIELD