Provider Demographics
NPI:1679590491
Name:SCUDERI, LEONARD J (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:SCUDERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23456 HAWTHORNE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4774
Mailing Address - Country:US
Mailing Address - Phone:310-791-5577
Mailing Address - Fax:310-791-5575
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4774
Practice Address - Country:US
Practice Address - Phone:310-791-5577
Practice Address - Fax:310-791-5575
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG59477207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG59477AOtherMEDICARE PPIN
CA00G594770OtherBLUE SHIELD
CAF38775Medicare UPIN
CAWG59477AOtherMEDICARE PPIN