Individual provider Active NPI

Jeffrey O Leach, M.D., INC

  • Specialist
  • Vista, CA
National Provider Identifier
1285665653
Registry record updated Jan 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G30939 Issued in CA
Practice address
2067 W Vista Way
Suite 200
Vista, CA 92083-6031
Phone
(760) 941-9844
Fax
(760) 630-5716
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G30939 CA Primary

Addresses

Primary practice location

2067 W Vista Way
Suite 200
Vista, CA 92083-6031

Mailing address

2067 W Vista Way
Suite 200
Vista, CA 92083-6031
Phone (760) 941-9844

Other identifiers 1

IdentifierTypeStateIssuer
OOG309390MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G30939CAMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390867200000",
    "number": "1285665653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY",
            "address_2": "SUITE 200",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836031",
            "telephone_number": "760-941-9844",
            "fax_number": "760-630-5716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY",
            "address_2": "SUITE 200",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836031",
            "telephone_number": "760-941-9844",
            "fax_number": "760-630-5716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEACH",
        "first_name": "JEFFREY",
        "middle_name": "O",
        "credential": "M.D., INC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2014-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G30939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG309390",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; 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.