Provider Demographics
NPI:1740639319
Name:LEIDERMAN, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LEIDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PINE AVE STE 1030
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2366
Mailing Address - Country:US
Mailing Address - Phone:310-360-7200
Mailing Address - Fax:
Practice Address - Street 1:320 PINE AVE STE 1030
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2366
Practice Address - Country:US
Practice Address - Phone:310-360-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53454363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant