Provider Demographics
NPI:1568471944
Name:TAMARA M. LEONAS D.O., INC.
Entity Type:Organization
Organization Name:TAMARA M. LEONAS D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-695-9183
Mailing Address - Street 1:28910 RANCHO CALIFORNIA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-1869
Mailing Address - Country:US
Mailing Address - Phone:951-695-9183
Mailing Address - Fax:951-676-6964
Practice Address - Street 1:28910 RANCHO CALIFORNIA RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1869
Practice Address - Country:US
Practice Address - Phone:951-695-9183
Practice Address - Fax:951-676-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6984207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD8871OtherMEDICARE RAILROAD
CA00AX69840Medicaid
CADD8871OtherMEDICARE RAILROAD
020A69840Medicare ID - Type Unspecified