Provider Demographics
NPI:1275101800
Name:AGHAJANI, LEEA (MSN-ED, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LEEA
Middle Name:
Last Name:AGHAJANI
Suffix:
Gender:F
Credentials:MSN-ED, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MIRA LOMA AVE
Mailing Address - Street 2:APT 109
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3511
Mailing Address - Country:US
Mailing Address - Phone:818-334-3377
Mailing Address - Fax:
Practice Address - Street 1:10802 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1579
Practice Address - Country:US
Practice Address - Phone:562-924-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027394363LP0808X
CA95032593163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health