Provider Demographics
NPI:1649200817
Name:REARDON, LEIGH CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:CHRISTOPHER
Last Name:REARDON
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 1:100 UCLA MEDICAL PLZ
Mailing Address - Street 2:SUITE 630
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6970
Mailing Address - Country:US
Mailing Address - Phone:310-794-2727
Mailing Address - Fax:310-825-6346
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 630
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1679
Practice Address - Country:US
Practice Address - Phone:310-794-2727
Practice Address - Fax:310-825-6346
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94973207R00000X, 208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649200817Medicaid
CAEU359YMedicare PIN
CAEU359ZMedicare PIN