Provider Demographics
NPI:1699940676
Name:PANDAC, LEONARDO P (PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:P
Last Name:PANDAC
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:162 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4343
Mailing Address - Country:US
Mailing Address - Phone:213-810-0270
Mailing Address - Fax:213-413-5456
Practice Address - Street 1:2001 BEVERLY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2400
Practice Address - Country:US
Practice Address - Phone:213-413-1622
Practice Address - Fax:213-413-5456
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-936409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)