Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | A98610 | CA |
NPI | 1073636940 |
---|---|
Provider Name | Dr. Leo Pevzner |
First Address | Trabuco Canyon, CA 92679-1233 |
Second Address | Orange, CA 92868-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 04/11/2021 |