Provider Demographics
NPI:1093057234
Name:FROMER, LEONARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:FROMER
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 1:15525 HAMNER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1804
Mailing Address - Country:US
Mailing Address - Phone:310-383-8168
Mailing Address - Fax:310-471-5392
Practice Address - Street 1:15525 HAMNER DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1804
Practice Address - Country:US
Practice Address - Phone:310-383-8168
Practice Address - Fax:310-471-5392
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine