Provider Demographics
NPI:1376983429
Name:IRVINE, LESLIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 ROSECRANS AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2470
Mailing Address - Country:US
Mailing Address - Phone:424-225-1280
Mailing Address - Fax:617-687-7722
Practice Address - Street 1:1200 ROSECRANS AVE STE 110
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2470
Practice Address - Country:US
Practice Address - Phone:424-225-1280
Practice Address - Fax:617-687-7722
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125702207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery