Provider Demographics
NPI:1053053330
Name:SANTOS, LEONARDO CAJAYON JR (RN)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:CAJAYON
Last Name:SANTOS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 E DIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4802
Mailing Address - Country:US
Mailing Address - Phone:714-600-9896
Mailing Address - Fax:
Practice Address - Street 1:7912 POINSETTIA DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1933
Practice Address - Country:US
Practice Address - Phone:714-600-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627235163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty