Provider Demographics
NPI:1114952876
Name:MATALON, LEOR (MD)
Entity Type:Individual
Prefix:
First Name:LEOR
Middle Name:
Last Name:MATALON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8070 LA JOLLA SHORES DR
Mailing Address - Street 2:265
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3230
Mailing Address - Country:US
Mailing Address - Phone:760-826-2120
Mailing Address - Fax:858-764-2820
Practice Address - Street 1:440 S MELROSE DR STE 201
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6666
Practice Address - Country:US
Practice Address - Phone:760-452-5150
Practice Address - Fax:858-764-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA629502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH65212Medicare UPIN