Provider Demographics
NPI:1407057854
Name:LEUS, INE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:INE
Middle Name:MARIE
Last Name:LEUS
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 1:1332 PARK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4545
Mailing Address - Country:US
Mailing Address - Phone:510-523-3417
Mailing Address - Fax:
Practice Address - Street 1:1332 PARK ST STE 202
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4545
Practice Address - Country:US
Practice Address - Phone:510-523-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258408208000000X, 207R00000X
390200000X
CAC171601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine