Provider Demographics
NPI:1346063781
Name:LEANOS, EDUARDO
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:LEANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:
Other - Last Name:LEANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:CATHEYS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95306-0263
Mailing Address - Country:US
Mailing Address - Phone:209-325-5280
Mailing Address - Fax:209-742-0994
Practice Address - Street 1:PO BOX 99
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-0099
Practice Address - Country:US
Practice Address - Phone:209-097-6940
Practice Address - Fax:209-742-0994
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health