Provider Demographics
NPI:1346813755
Name:LOPEZ, LEANNAH MARIE (CAREGIVER)
Entity Type:Individual
Prefix:
First Name:LEANNAH
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 LA CRESENTA CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1608
Mailing Address - Country:US
Mailing Address - Phone:530-923-3440
Mailing Address - Fax:
Practice Address - Street 1:1522 LA CRESENTA CT
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-1608
Practice Address - Country:US
Practice Address - Phone:530-923-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider