Provider Demographics
NPI:1235886367
Name:VANG, LELAND NHIA YIA
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:NHIA YIA
Last Name:VANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4233
Mailing Address - Country:US
Mailing Address - Phone:559-864-0211
Mailing Address - Fax:
Practice Address - Street 1:3240 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-1033
Practice Address - Country:US
Practice Address - Phone:559-486-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician