Active NPI
Leo Indianer, MD
- Dermatology Physician
- Encino, CA
National Provider Identifier
1710075858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- C25642
- Practice address
- 16260 Ventura Blvd
#515
Encino, CA 91436 - Phone
- (818) 788-5216
- Fax
- (818) 788-2702
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | C25642 | CA | Primary |
| Dermatopathology Physician | 207ND0900X | C25642 | CA |
Addresses
Primary practice location
16260 Ventura Blvd
#515
Encino, CA 91436
Mailing address
16260 Ventura Blvd
#515
Encino, CA 91436
Phone (818) 788-5216
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ59180Z | Medicaid | CA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| C25642 | CA | MD | Dermatopathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents Univ of Calif Los Angeles | Past | Accepting new patients |
Organizations & group practices 1
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.
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- Los Angeles, CA
- NPI 1952308363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393545600000",
"number": "1710075858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16260 VENTURA BLVD",
"address_2": "#515",
"city": "ENCINO",
"state": "CA",
"postal_code": "91436",
"telephone_number": "818-788-5216",
"fax_number": "818-788-2702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16260 VENTURA BLVD",
"address_2": "#515",
"city": "ENCINO",
"state": "CA",
"postal_code": "91436",
"telephone_number": "818-788-5216",
"fax_number": "818-788-2702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDIANER",
"first_name": "LEO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2014-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CA",
"license": "C25642",
"primary": true
},
{
"code": "207ND0900X",
"taxonomy_group": "",
"desc": "Dermatology, Dermatopathology",
"state": "CA",
"license": "C25642",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ59180Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
- Impulse Imaging Inc.
- In-Line Medical, Inc., a Professional Medical Corporation
- Indar Sarransingh MD a Medical Corp
- Independent Physical Therapy Inc
- Indianer, Lask & Rosenzweig, M.D.'S, Dermatology Group, a Medical Corp
- Infinity Mobile Medical Group
- Infinity Wound Care Specialist
- Paul Richard Inglizian, LCSW
- John-Arthur Ingram, AMFT
- Adriana Iniguez
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.