Provider Demographics
NPI:1588362669
Name:LEADWEST MEDICAL CORPORATION
Entity type:Organization
Organization Name:LEADWEST MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:AURORA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:925-984-4184
Mailing Address - Street 1:2549 EASTBLUFF DR STE B781
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3500
Mailing Address - Country:US
Mailing Address - Phone:714-584-8824
Mailing Address - Fax:
Practice Address - Street 1:802 MAGNOLIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3124
Practice Address - Country:US
Practice Address - Phone:714-584-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty