Provider Demographics
NPI:1679574693
Name:RAY, LEENA S (MD)
Entity Type:Individual
Prefix:
First Name:LEENA
Middle Name:S
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 EAST STREET
Mailing Address - Street 2:STE 305
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2066
Mailing Address - Country:US
Mailing Address - Phone:925-686-1230
Mailing Address - Fax:925-686-8443
Practice Address - Street 1:2222 EAST STREET
Practice Address - Street 2:STE 305
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2066
Practice Address - Country:US
Practice Address - Phone:925-686-1230
Practice Address - Fax:925-686-8443
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84526207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00163009OtherMEDICARE RAILROAD
CP2044OtherMEDICARE RAILROAD
CAGR0020610Medicaid
00A845260Medicare ID - Type Unspecified
ZZZ96217ZMedicare ID - Type Unspecified
I10107Medicare UPIN