Provider Demographics
NPI:1215101324
Name:LEO JIREH C ABELITA DMD INC
Entity type:Organization
Organization Name:LEO JIREH C ABELITA DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO JIREH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABELITA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-539-1224
Mailing Address - Street 1:1809 AND A HALF LOMITA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1905
Mailing Address - Country:US
Mailing Address - Phone:310-539-1224
Mailing Address - Fax:310-530-5796
Practice Address - Street 1:1809 AND A HALF LOMITA BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1905
Practice Address - Country:US
Practice Address - Phone:310-539-1224
Practice Address - Fax:310-530-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9260602OtherDENTI CAL