Provider Demographics
NPI:1477930386
Name:NAZARENO, LEILA (MA)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:NAZARENO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROMENADE CIR
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-6313
Mailing Address - Country:US
Mailing Address - Phone:707-208-4959
Mailing Address - Fax:
Practice Address - Street 1:510 16TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1520
Practice Address - Country:US
Practice Address - Phone:510-357-5515
Practice Address - Fax:510-318-5399
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health