Provider Demographics
NPI:1326138355
Name:LEIBOLD, SCOTT HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HOWARD
Last Name:LEIBOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:HOWARD
Other - Last Name:LEIBOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:68 RISING HILL RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4918
Mailing Address - Country:US
Mailing Address - Phone:805-217-7824
Mailing Address - Fax:818-924-4217
Practice Address - Street 1:68 RISING HILL RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4918
Practice Address - Country:US
Practice Address - Phone:805-217-7824
Practice Address - Fax:818-924-4217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4073213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine