Provider Demographics
NPI:1114042611
Name:PATRICK-GATES, LEAH RAYE (DO)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RAYE
Last Name:PATRICK-GATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:24910 LAS BRISAS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4010
Mailing Address - Country:US
Mailing Address - Phone:951-231-1385
Mailing Address - Fax:951-461-9191
Practice Address - Street 1:24910 LAS BRISAS RD
Practice Address - Street 2:STE 105
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-231-1385
Practice Address - Fax:951-461-9191
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZ20041ZMedicare Oscar/Certification