Basic Information
| Provider Information | |||||||||
| NPI: | 1508225111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASTARABADI | ||||||||
| FirstName: | LEILA | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4676 SIERRA TREE LN | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926122245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172736530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1202 BRISTOL ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926268605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144249001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2016 | ||||||||
| LastUpdateDate: | 02/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172M00000X | 68162 | CA | Y | Other Service Providers | Mechanotherapist |
No ID Information.