1972068096 NPI number — MRS. LEONIE B KAWAGUCHI COTA

Table of content: MRS. LEONIE B KAWAGUCHI COTA (NPI 1972068096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972068096 NPI number — MRS. LEONIE B KAWAGUCHI COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAWAGUCHI
Provider First Name:
LEONIE
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAPULONG
Provider Other First Name:
LEONIE
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972068096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15334 GOODHUE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90604-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-378-6140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 N BREA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92821-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-529-6842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2019

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: 224Z00000X , with the licence number:  OTA4744 , 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)