Provider Demographics
NPI:1316418551
Name:LEADING EDGE INNOVATIONS
Entity type:Organization
Organization Name:LEADING EDGE INNOVATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DWORK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-388-7669
Mailing Address - Street 1:699 MOBIL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6315
Mailing Address - Country:US
Mailing Address - Phone:805-388-7669
Mailing Address - Fax:805-389-8142
Practice Address - Street 1:699 MOBIL AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6315
Practice Address - Country:US
Practice Address - Phone:805-388-7669
Practice Address - Fax:805-389-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies