Leila Ettefagh, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A89632 Issued in CA

Practice address

360 San Miguel Dr
Suite 501
Newport Beach, CA 92660-7853

Phone

(949) 720-1170

Fax

(949) 720-1172

NPI assigned

May 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of California, San Francisco School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Island Dermatology, Inc.Group PAC ID 1850395070, 27 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

94.66 of 100Reported as group

Promoting interoperability

92

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Island Dermatology, Inc

  • Dermatology Physician
  • Newport Beach, CA
  • NPI 1508815556
  Medicare reassignment Care Compare group
• Hoag Memorial Hospital Presbyterian

  • General Acute Care Hospital
  • Newport Beach, CA
  • NPI 1518951300
  NPD (past)

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1881643724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 SAN MIGUEL DR",
            "address_2": "SUITE 501",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607853",
            "telephone_number": "949-720-1170",
            "fax_number": "949-720-1172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SAN MIGUEL DR",
            "address_2": "SUITE 501",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607853",
            "telephone_number": "949-720-1170",
            "fax_number": "949-720-1172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTEFAGH",
        "first_name": "LEILA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A89632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milinda Chidera Estrada, PA-C
• Vitzania Estrada
• Etemad Dental Inc
• Tara Etemad-Haary, LMFT
• Abrak Etemad, DMD
• Eugene K Kim MD Inc
• Evangeline Chu MD a Medical Corporation
• Andre Evans, AMFT-122136
• April R Evans, M.D.
• Corwin Winslow Evans, D.D.S.

• Dermatology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.