Provider Demographics
NPI:1023407707
Name:THE LEELA INTEGRATIVE MEDICINE CENTER, INC
Entity type:Organization
Organization Name:THE LEELA INTEGRATIVE MEDICINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:MELINDA DIANNE
Authorized Official - Last Name:ANVEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-0411
Mailing Address - Street 1:50 BELLEFONTAINE ST
Mailing Address - Street 2:307
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-795-0411
Mailing Address - Fax:626-795-0080
Practice Address - Street 1:50 BELLEFONTAINE ST
Practice Address - Street 2:307
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-795-0411
Practice Address - Fax:626-795-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty