Provider Demographics
NPI:1619394830
Name:STANLEY J. LEIKEN, MD INC.
Entity Type:Organization
Organization Name:STANLEY J. LEIKEN, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-783-0908
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:1050
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-783-0908
Mailing Address - Fax:818-783-3832
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:1050
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-783-0908
Practice Address - Fax:818-783-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7019261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)