Provider Demographics
NPI:1194832642
Name:LESHAN, LOREN A (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:A
Last Name:LESHAN
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 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5559
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:19950 RINALDI ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-403-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25641207Q00000X
FLME98855207Q00000X
CAG86992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50655OtherBCBS
FL0007427-00Medicaid
FLP00760798OtherRR MEDICARE
FLK1951AOtherBPC MEDICARE GROUP PTAN
FLP00760798OtherRR MEDICARE
FLAL749TMedicare PIN
FL0007427-00Medicaid
FLAL749ZMedicare PIN
FLAL749YMedicare PIN