Provider Demographics
NPI:1386172419
Name:SHEIKHOLESLAM, LEILA (DO)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:SHEIKHOLESLAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:SHEIKH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 OCEAN PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5244
Practice Address - Country:US
Practice Address - Phone:310-450-1200
Practice Address - Fax:310-450-8830
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A18455OtherMEDICAL LICENSE
CAFS9696014OtherDEA