Provider Demographics
NPI:1609988633
Name:WESSEL, LELAND G (MD)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:G
Last Name:WESSEL
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 1:5700 HARDY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92182-4701
Mailing Address - Country:US
Mailing Address - Phone:619-594-4325
Mailing Address - Fax:
Practice Address - Street 1:4085 GOVERNOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2522
Practice Address - Country:US
Practice Address - Phone:714-389-5700
Practice Address - Fax:714-389-6973
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55184207P00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G551840Medicaid
CAWG55184BMedicare ID - Type Unspecified
CA00G551840Medicaid