Provider Demographics
NPI:1942215629
Name:NORTON, LEILANI (MD)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:STE A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6278
Mailing Address - Country:US
Mailing Address - Phone:530-344-2020
Mailing Address - Fax:530-622-9613
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:STE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2020
Practice Address - Fax:530-622-9613
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065830Medicaid
CAG50455OtherCA STATE LICENSE
CAG50455OtherCA STATE LICENSE