IndividualActive
Jerry San Diego, M.D.
NPI 1285694604 · Anatomic Pathology & Clinical Pathology Physician · Leavenworth, KS
Provider details
- NPI number
- 1285694604
- Entity type
- Individual
- Primary specialty
- Anatomic Pathology & Clinical Pathology PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- 024399 (LA)
Practice location
4101 S 4th St
P and Lms
Leavenworth, KS 66048-5014
Phone: (913) 682-2000
Fax: (913) 758-4193
Mailing address
4101 S 4th St
Leavenworth, KS 66048-5014
Registry dates
- Enumerated
- 2006-03-28
- Last updated
- 2014-08-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.