Provider Demographics
NPI:1184445744
Name:LEUENBERGER, JOHANN LEO (MTOM, LAC)
Entity type:Individual
Prefix:
First Name:JOHANN
Middle Name:LEO
Last Name:LEUENBERGER
Suffix:
Gender:M
Credentials:MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 EL ROBLE LN
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-1754
Mailing Address - Country:US
Mailing Address - Phone:310-622-5500
Mailing Address - Fax:
Practice Address - Street 1:2106 EL ROBLE LN
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-1754
Practice Address - Country:US
Practice Address - Phone:310-622-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist