Provider Demographics
NPI:1417996745
Name:HUNT, LEONEL A (MD)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:A
Last Name:HUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONEL
Other - Middle Name:ALEXANDRE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:444 S SAN VICENTE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4174
Mailing Address - Country:US
Mailing Address - Phone:310-423-9941
Mailing Address - Fax:310-423-8928
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9834
Practice Address - Fax:310-423-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72199174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72199OtherSTATE LICENSE
CAH73635Medicare UPIN