Provider Demographics
NPI:1255365722
Name:SHETH, LEENA S (MD)
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:S
Last Name:SHETH
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 1:1460 E HOLT AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5835
Mailing Address - Country:US
Mailing Address - Phone:909-980-3537
Mailing Address - Fax:909-484-5282
Practice Address - Street 1:1460 E HOLT AVE STE 10
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5835
Practice Address - Country:US
Practice Address - Phone:909-980-3537
Practice Address - Fax:909-484-5282
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46030173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A460300Medicaid
CA00A460300Medicaid
CAE82133Medicare UPIN