Provider Demographics
NPI:1396370995
Name:TAPIA QUIROZ, LEONOR
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:
Last Name:TAPIA QUIROZ
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 1:8321 W SAHARA AVE APT 2167
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1889
Mailing Address - Country:US
Mailing Address - Phone:714-699-0674
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE STE 800
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5955
Practice Address - Country:US
Practice Address - Phone:714-858-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician