Provider Demographics
NPI:1821078692
Name:CEDARS, LEONARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:A
Last Name:CEDARS
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 CASA ST
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1883
Mailing Address - Country:US
Mailing Address - Phone:805-546-2057
Mailing Address - Fax:805-784-0895
Practice Address - Street 1:100 CASA ST
Practice Address - Street 2:SUITE D-3
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1883
Practice Address - Country:US
Practice Address - Phone:805-546-2057
Practice Address - Fax:805-784-0895
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76782207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295741668OtherTYPE 1 NPI
1639159411OtherTYPE 2 NPI
CAD28280Medicare UPIN
CAWG76782AMedicare ID - Type UnspecifiedMEDICARE BILLING #