Provider Demographics
NPI:1548884521
Name:GADDI, LEON ALEXANDRA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LEON ALEXANDRA
Middle Name:
Last Name:GADDI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 EAST CAMBRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2984
Mailing Address - Country:US
Mailing Address - Phone:661-247-3017
Mailing Address - Fax:
Practice Address - Street 1:1308 EAST CAMBRIDGE COURT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2984
Practice Address - Country:US
Practice Address - Phone:661-247-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4705878163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health