Provider Demographics
NPI:1902854615
Name:OSTOVAR-KERMANI, LEILA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:OSTOVAR-KERMANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4338
Mailing Address - Country:US
Mailing Address - Phone:415-898-4828
Mailing Address - Fax:418-898-4878
Practice Address - Street 1:1615 HILL RD STE E
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4338
Practice Address - Country:US
Practice Address - Phone:415-898-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006158213E00000X
CAE5023213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist