Provider Demographics
NPI:1528207735
Name:WHITE, LEIGH MALONE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:MALONE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2108
Mailing Address - Country:US
Mailing Address - Phone:760-720-9898
Mailing Address - Fax:760-729-7016
Practice Address - Street 1:3140 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2108
Practice Address - Country:US
Practice Address - Phone:760-720-9898
Practice Address - Fax:760-729-7016
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22137310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22137Medicare PIN