Active NPI
Robert Leo, D.D.S.
- Dentist
- Susanville, CA
National Provider Identifier
1992989180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 27899
- Practice address
- 475-750 Rice Canyon Rd.
High Desert State Prison
Susanville, CA 96130 - Phone
- (530) 251-5100
- Fax
- (530) 251-5087
- NPI assigned
- Dec 24, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 27899 | CA | Primary |
Addresses
Primary practice location
475-750 Rice Canyon Rd.
High Desert State Prison
Susanville, CA 96130
Mailing address
PO Box 750
Susanville, CA 96127-0750
Phone (530) 251-5100
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27899 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198454400000",
"number": "1992989180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 750",
"city": "SUSANVILLE",
"state": "CA",
"postal_code": "961270750",
"telephone_number": "530-251-5100",
"fax_number": "530-251-5087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475-750 RICE CANYON RD.",
"address_2": "HIGH DESERT STATE PRISON",
"city": "SUSANVILLE",
"state": "CA",
"postal_code": "96130",
"telephone_number": "530-251-5100",
"fax_number": "530-251-5087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEO",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-24",
"last_updated": "2007-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "27899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Susanville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.