Provider Demographics
NPI:1467877795
Name:CARDONE, LEATRICE ANNE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:LEATRICE
Middle Name:ANNE
Last Name:CARDONE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 HALL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-2415
Mailing Address - Country:US
Mailing Address - Phone:805-648-5812
Mailing Address - Fax:
Practice Address - Street 1:2501 HALL CANYON RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2415
Practice Address - Country:US
Practice Address - Phone:805-648-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA49302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization