Provider Demographics
NPI:1962751552
Name:DAVALOS, LESLIE MUNIZ (LVN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MUNIZ
Last Name:DAVALOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LAS RIENDAS DR APT NO77
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7555
Mailing Address - Country:US
Mailing Address - Phone:562-480-1648
Mailing Address - Fax:
Practice Address - Street 1:1301 LAS RIENDAS DR APT NO77
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7555
Practice Address - Country:US
Practice Address - Phone:562-480-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245275164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7161240Medicaid