Provider Demographics
NPI:1710955919
Name:LOCHNER, LESLIE T (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:T
Last Name:LOCHNER
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 1:352 3RD ST
Mailing Address - Street 2:SUITE# 202
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2357
Mailing Address - Country:US
Mailing Address - Phone:949-376-6600
Mailing Address - Fax:949-376-9133
Practice Address - Street 1:352 3RD ST
Practice Address - Street 2:SUITE# 202
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2357
Practice Address - Country:US
Practice Address - Phone:949-376-6600
Practice Address - Fax:949-376-9133
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X174400000X
CAG66585207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G665850Medicaid
CA00G665850Medicaid
CAG66585AMedicare PIN