Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A125702 | CA |
N | 207YS0123X | Facial Plastic Surgeon | A125702 | CA |
NPI | 1376983429 |
---|---|
Provider Name | Dr. Leslie E Irvine |
First Address | Manhattan Beach, CA 90266-2470 |
Second Address | Manhattan Beach, CA 90266-2470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2013 |
Last Update Date | 29/07/2019 |