Provider Demographics
NPI:1417928599
Name:LOVITCH, LEONARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:MICHAEL
Last Name:LOVITCH
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 1:4400 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2440
Mailing Address - Country:US
Mailing Address - Phone:562-818-5848
Mailing Address - Fax:562-426-6400
Practice Address - Street 1:4400 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2440
Practice Address - Country:US
Practice Address - Phone:562-818-5848
Practice Address - Fax:562-426-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19446208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G19446Medicaid
CA00G19446Medicaid
CA050175Medicare ID - Type Unspecified