Provider Demographics
NPI:1134285547
Name:LEONARD S. KURIAN, M D A MEDICAL CORP.
Entity Type:Organization
Organization Name:LEONARD S. KURIAN, M D A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-726-7200
Mailing Address - Street 1:1331 W AVENUE J
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2942
Mailing Address - Country:US
Mailing Address - Phone:661-726-7200
Mailing Address - Fax:661-726-7261
Practice Address - Street 1:1331 W AVENUE J
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2942
Practice Address - Country:US
Practice Address - Phone:661-726-7200
Practice Address - Fax:661-726-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G704890Medicaid
CAG70489Medicare ID - Type Unspecified