Provider Demographics
NPI:1417796582
Name:LEAL, ILEANA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:LEAL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:PIXIE
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8632 C AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1528
Mailing Address - Country:US
Mailing Address - Phone:760-910-4357
Mailing Address - Fax:
Practice Address - Street 1:1500 S HAVEN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2969
Practice Address - Country:US
Practice Address - Phone:909-749-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician