Basic Information
| Provider Information | |||||||||
| NPI: | 1194108597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEYTON GREEN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEYTON BERMUDEZ | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | VANESSA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 CALIFORNIA ST | ||||||||
| Address2: | FL 7 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941041415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105610279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8600 WARD PKWY STE 1018 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641142616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162815397 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2015 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2019011352 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.