Provider Demographics
NPI:1982722187
Name:OSCAR I. LEAL MD A PROF CORP
Entity Type:Organization
Organization Name:OSCAR I. LEAL MD A PROF CORP
Other - Org Name:DBA: BEVERLY HILLS LASER & SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-275-8895
Mailing Address - Street 1:99 N. LA CIENEGA BLVD, SUITE 106
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-652-4000
Mailing Address - Fax:310-652-4020
Practice Address - Street 1:99 N. LA CIENEGA BLVD, SUITE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-652-4000
Practice Address - Fax:310-652-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005528OtherBLUE CROSS ID #