Provider Demographics
NPI:1093931727
Name:BOLANDGRAY, LEILA SOFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:SOFIA
Last Name:BOLANDGRAY
Suffix:
Gender:F
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:PO BOX 2775
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2775
Mailing Address - Country:US
Mailing Address - Phone:619-937-6349
Mailing Address - Fax:866-313-8916
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-937-6349
Practice Address - Fax:866-313-8916
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine