Provider Demographics
NPI:1306112206
Name:LEATHERS, SHAMILA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMILA
Middle Name:
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMILA
Other - Middle Name:
Other - Last Name:MOKFI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:9920 TALBERT AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143712207L00000X
CAA 120506207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB211896 (OCM)Medicare PIN
CAGH801A (SOLO)Medicare PIN
CAP01408136 (OCM)Medicare PIN
CAP01696871 (SOLO)Medicare PIN