Provider Demographics
NPI:1356806798
Name:LELAND, JUSTIN
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:LELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 S FELTS CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-9658
Mailing Address - Country:US
Mailing Address - Phone:509-869-0788
Mailing Address - Fax:
Practice Address - Street 1:4320 S FELTS CT
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-9658
Practice Address - Country:US
Practice Address - Phone:509-869-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies