Provider Demographics
NPI:1053069021
Name:FALLAS, LEONA A
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:A
Last Name:FALLAS
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 1:10116 EMPYREAN WAY APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3807
Mailing Address - Country:US
Mailing Address - Phone:310-658-9865
Mailing Address - Fax:
Practice Address - Street 1:8831 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3223
Practice Address - Country:US
Practice Address - Phone:310-204-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)