Provider Demographics
NPI:1700830304
Name:RAWSON, LEONARD G (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:G
Last Name:RAWSON
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 1:8255 FIRESTONE BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4800
Mailing Address - Country:US
Mailing Address - Phone:562-319-2085
Mailing Address - Fax:562-923-7112
Practice Address - Street 1:8255 FIRESTONE BLVD
Practice Address - Street 2:SUITE # 501
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4800
Practice Address - Country:US
Practice Address - Phone:562-319-2085
Practice Address - Fax:562-923-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
013871OtherHEALTH NET ID #
110179509OtherRAILROAD
P00370566OtherRAILROAD
00G283000OtherBLUE SHIELD ID #
CA00G283000Medicaid
P00370566OtherRAILROAD
013871OtherHEALTH NET ID #
110179509OtherRAILROAD
A43684Medicare UPIN