Provider Demographics
NPI:1912920836
Name:WOODSON, LEILANI MISAJON (MD)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:MISAJON
Last Name:WOODSON
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 1:2683 PACIFIC AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2610
Mailing Address - Country:US
Mailing Address - Phone:562-989-5722
Mailing Address - Fax:562-989-5732
Practice Address - Street 1:2683 PACIFIC AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2610
Practice Address - Country:US
Practice Address - Phone:562-989-5722
Practice Address - Fax:562-989-5732
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77130207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI23387Medicare UPIN