Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A108820 | CA |
N | 208600000X | Surgeon | A108820 | CA |
Y | 2082S0105X | Plastic Hand Surgeon | A108820 | CA |
NPI | 1649442328 |
---|---|
Provider Name | Ms. Amber Rachel Leis |
First Address | Orange, CA 92868-3217 |
Second Address | Orange, CA 92868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2008 |
Last Update Date | 19/05/2015 |