Provider Demographics
NPI:1902070808
Name:LESLIE J. GULLAHORN, INC.
Entity Type:Organization
Organization Name:LESLIE J. GULLAHORN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GULLAHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-977-2717
Mailing Address - Street 1:2142 BULRUSH LN
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1408
Mailing Address - Country:US
Mailing Address - Phone:619-977-2717
Mailing Address - Fax:760-274-6333
Practice Address - Street 1:9900 GENESEE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1210
Practice Address - Country:US
Practice Address - Phone:858-678-0455
Practice Address - Fax:858-678-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty