Provider Demographics
NPI:1447360888
Name:JABAJI, LEILA KHOURY (MD)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:KHOURY
Last Name:JABAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N DIAMOND BAR BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1023
Mailing Address - Country:US
Mailing Address - Phone:909-861-1888
Mailing Address - Fax:909-861-1077
Practice Address - Street 1:750 N DIAMOND BAR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1023
Practice Address - Country:US
Practice Address - Phone:909-861-1888
Practice Address - Fax:909-861-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40179174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF38072Medicare UPIN