Provider Demographics
NPI:1427332881
Name:SALES, HAECKEL LEO J
Entity type:Individual
Prefix:
First Name:HAECKEL LEO
Middle Name:J
Last Name:SALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12933 DROXFORD ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6067
Mailing Address - Country:US
Mailing Address - Phone:562-450-7632
Mailing Address - Fax:
Practice Address - Street 1:12933 DROXFORD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6067
Practice Address - Country:US
Practice Address - Phone:562-450-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist