Provider Demographics
NPI:1215047303
Name:ABELITA, LEO JIREH CIOCO (DMD)
Entity type:Individual
Prefix:DR
First Name:LEO JIREH
Middle Name:CIOCO
Last Name:ABELITA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ELIGIO
Other - Middle Name:
Other - Last Name:ABELITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 1/2 WEST LOMITA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717
Mailing Address - Country:US
Mailing Address - Phone:310-539-1224
Mailing Address - Fax:310-530-5796
Practice Address - Street 1:1809 1/2 WEST LOMITA BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:310-539-1224
Practice Address - Fax:310-530-5796
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist