Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | AC0330821 | CA |
NPI | 1538387246 |
---|---|
Provider Name | Dr. Leo Herbert Cummins |
First Address | Laguna Beach, CA 92651-1206 |
Second Address | Laguna Beach, CA 92651-1206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |