Leah M Vergara, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

51680 Issued in CA

Practice address

11160 Warner Ave Ste 311
Fountain Valley, CA 92708-4055

Phone

(714) 850-7300

Fax

(714) 850-7310

NPI assigned

Aug 12, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Leah M Hanson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Long Beach - Lakewood Orthopedic Institute

  • Multi-Specialty Clinic/Center
  • Lakewood, CA
  • NPI 1710020755

  Surgical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1053720359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15848",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926595848",
            "telephone_number": "657-241-3600",
            "fax_number": "657-241-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 WARNER AVE STE 311",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084055",
            "telephone_number": "714-850-7300",
            "fax_number": "714-850-7310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3828 Schaufele Ave Ste 320",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908081793",
            "country_code": "US",
            "telephone_number": "562-348-4588",
            "fax_number": "562-420-2545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5750 Downey Ave Ste 308",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CA",
            "postal_code": "907121482",
            "country_code": "US",
            "telephone_number": "562-633-3787",
            "fax_number": "562-633-1977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERGARA",
        "first_name": "LEAH",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-12",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51680",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "51680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEAH",
            "last_name": "HANSON",
            "middle_name": "M",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Surgical Physician Assistant in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.