Provider Demographics
NPI:1538185178
Name:SCHOENFELD, LEON SANDY (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:SANDY
Last Name:SCHOENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 NOGALES DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5114
Mailing Address - Country:US
Mailing Address - Phone:818-705-5773
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE # 504
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-345-0664
Practice Address - Fax:818-345-1866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF01871Medicare UPIN