Provider Demographics
NPI:1134278740
Name:AVALLONE, LEOPOLD THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOPOLD
Middle Name:THOMAS
Last Name:AVALLONE
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 1:432 VIA LIDO NORD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4927
Mailing Address - Country:US
Mailing Address - Phone:310-795-8201
Mailing Address - Fax:
Practice Address - Street 1:1367 AVENIDA DE CORTEZ
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2124
Practice Address - Country:US
Practice Address - Phone:310-795-8201
Practice Address - Fax:310-459-3467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA022137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist