Provider Demographics
NPI:1528612322
Name:LEON, ANGELA C
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 ORANGE AVE SPC C17
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-8349
Mailing Address - Country:US
Mailing Address - Phone:562-964-3211
Mailing Address - Fax:
Practice Address - Street 1:15325 ORANGE AVE SPC C17
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-8349
Practice Address - Country:US
Practice Address - Phone:562-964-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM584176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife