Provider Demographics
NPI:1821202060
Name:BRIAN J. LEBERTHON, MD., A MEDICAL
Entity Type:Organization
Organization Name:BRIAN J. LEBERTHON, MD., A MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. , PRESIDENT OF CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEBERTHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-338-9560
Mailing Address - Street 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-338-9560
Mailing Address - Fax:626-338-9360
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-338-9560
Practice Address - Fax:626-338-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79934207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G799340Medicaid
CAG98159Medicare UPIN
CAWG79934DMedicare PIN