1497133805 NPI number — LEONARD ANTHONY ARREDONDO L.V.N.

Table of content: LEONARD ANTHONY ARREDONDO L.V.N. (NPI 1497133805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497133805 NPI number — LEONARD ANTHONY ARREDONDO L.V.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARREDONDO
Provider First Name:
LEONARD
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.V.N.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARREDONDO
Provider Other First Name:
LEONARD
Provider Other Middle Name:
ANTHONY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.V.N.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497133805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N CENTRAL AVE
Provider Second Line Business Mailing Address:
250
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203-3905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-539-8359
Provider Business Mailing Address Fax Number:
855-245-8903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
250
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-539-8359
Provider Business Practice Location Address Fax Number:
855-245-8903
Provider Enumeration Date:
05/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164X00000X , with the licence number:  251726 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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