Provider Demographics
NPI:1710275722
Name:NESHATIAN, LEILA NESHATIAN (MD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:NESHATIAN
Last Name:NESHATIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:NESHATIAN
Other - Last Name:NESHATIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106246207RG0100X
NY003872207R00000X
TXQ4648207RG0100X
CAA150264207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FE041OtherBLUE CROSS BLUE SHIELD
TX8FX346OtherBCBS
TXP01717204OtherRR MEDICARE
TX348455202Medicaid
TX348455203Medicaid
TX348455201Medicaid
TXP01717204OtherRR MEDICARE
TX425717ZSWDMedicare PIN
TX348455201Medicaid
TX425717ZSWCMedicare PIN