Provider Demographics
NPI:1265459705
Name:LEITMAN, MICHAEL CHARLES (PH D PSYCHOLOGY)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:LEITMAN
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Gender:M
Credentials:PH D PSYCHOLOGY
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Mailing Address - Street 1:74075 EL PASEO
Mailing Address - Street 2:SUITE A 12
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4118
Mailing Address - Country:US
Mailing Address - Phone:760-346-3664
Mailing Address - Fax:760-346-7117
Practice Address - Street 1:74075 EL PASEO
Practice Address - Street 2:SUITE A 12
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4118
Practice Address - Country:US
Practice Address - Phone:760-346-3664
Practice Address - Fax:760-346-7117
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 5899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00 PL 58990Medicare ID - Type Unspecified
00 PL 58990Medicare UPIN