Provider Demographics
NPI:1184622417
Name:LEFFERMAN, MATTHEW GREG (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GREG
Last Name:LEFFERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 W. PICO BLVD.
Mailing Address - Street 2:SUITE #230
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1385
Mailing Address - Country:US
Mailing Address - Phone:310-356-8146
Mailing Address - Fax:310-356-8142
Practice Address - Street 1:9233 W. PICO BLVD.
Practice Address - Street 2:SUITE #230
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1385
Practice Address - Country:US
Practice Address - Phone:310-356-8146
Practice Address - Fax:310-356-8142
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106172Medicare UPIN