Provider Demographics
NPI:1396076899
Name:GALEANO, LESLIE CARINA (DA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CARINA
Last Name:GALEANO
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CARINA
Other - Last Name:GALEANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DA
Mailing Address - Street 1:124 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221
Mailing Address - Country:US
Mailing Address - Phone:562-618-8879
Mailing Address - Fax:
Practice Address - Street 1:124 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:562-618-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4481032126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4481032OtherCALIFORNIA DENTAL BOARD