Provider Demographics
NPI:1568088110
Name:LEROUX, IVAN ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:ERNESTO
Last Name:LEROUX
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 1:1701 S FIGUEROA ST # 1434
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3419
Mailing Address - Country:US
Mailing Address - Phone:464-322-9916
Mailing Address - Fax:
Practice Address - Street 1:330 E 7TH ST FL 2
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6740
Practice Address - Country:US
Practice Address - Phone:800-213-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA183662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine