Provider Demographics
NPI:1902008550
Name:LEACH-RODRIGUEZ DE ARRIBA, ERIC G (NP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:LEACH-RODRIGUEZ DE ARRIBA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:RM 1205
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5411
Practice Address - Country:US
Practice Address - Phone:212-627-7560
Practice Address - Fax:212-627-7563
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF332524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS87733Medicare UPIN