Provider Demographics
NPI:1447739677
Name:COLEMAN-LEOPOLD, FREDERICK DONTAE
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:DONTAE
Last Name:COLEMAN-LEOPOLD
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 1:24505 S AVALON BLVD APT 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1068
Mailing Address - Country:US
Mailing Address - Phone:562-253-4922
Mailing Address - Fax:
Practice Address - Street 1:24505 S AVALON BLVD #12
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-9074
Practice Address - Country:US
Practice Address - Phone:562-253-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator