Provider Demographics
NPI:1376832402
Name:IRENE P LEECH MD INC
Entity type:Organization
Organization Name:IRENE P LEECH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-590-8500
Mailing Address - Street 1:1040 ELM AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3267
Mailing Address - Country:US
Mailing Address - Phone:562-590-8500
Mailing Address - Fax:562-435-8477
Practice Address - Street 1:1040 ELM AVE STE 307
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3267
Practice Address - Country:US
Practice Address - Phone:562-590-8500
Practice Address - Fax:562-435-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41993207RG0300X, 207RP1001X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G419930Medicaid
CA00G419930Medicaid