Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A119718 | CA |
NPI | 1003133216 |
---|---|
Provider Name | Tracy Leong |
First Address | Riverside, CA 92506-2614 |
Second Address | Riverside, CA 92506-2614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 26/02/2020 |