Provider Demographics
NPI:1528565272
Name:HOLBROOK, LEILANI (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILANI
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILANI
Other - Middle Name:
Other - Last Name:BEAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 PINION DR
Mailing Address - Street 2:
Mailing Address - City:AIR FORCE ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840
Mailing Address - Country:US
Mailing Address - Phone:812-325-0238
Mailing Address - Fax:
Practice Address - Street 1:4201 PINION DR
Practice Address - Street 2:
Practice Address - City:AIR FORCE ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:812-325-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0069029207ZP0102X
VA0101268294208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology