Provider Demographics
NPI:1528170610
Name:MEJIA, LEONIDAS VOLTAIRE SISON (MD)
Entity type:Individual
Prefix:DR
First Name:LEONIDAS VOLTAIRE
Middle Name:SISON
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13849 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7428
Mailing Address - Country:US
Mailing Address - Phone:909-591-9724
Mailing Address - Fax:
Practice Address - Street 1:4075 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2525
Practice Address - Country:US
Practice Address - Phone:323-264-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80800207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA80800DOtherMEDICARE
CA00A808000Medicaid
CA00A808000Medicaid
CAWA80800DMedicare PIN