Provider Demographics
NPI:1902830987
Name:LAPP, LELAND DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:DALE
Last Name:LAPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4060 FOURTH AVENUE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-299-3111
Mailing Address - Fax:619-255-5535
Practice Address - Street 1:4060 FOURTH AVENUE
Practice Address - Street 2:SUITE 640
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-299-3111
Practice Address - Fax:619-255-5535
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG26593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00G265931Medicaid
GA00G265931Medicaid