Provider Demographics
NPI:1497401129
Name:ABALON, LEAH LORRAINE FERNANDO (LVN)
Entity Type:Individual
Prefix:
First Name:LEAH LORRAINE
Middle Name:FERNANDO
Last Name:ABALON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:3391 JOLA CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95832-1548
Mailing Address - Country:US
Mailing Address - Phone:510-253-5203
Mailing Address - Fax:
Practice Address - Street 1:9340 E STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1563
Practice Address - Country:US
Practice Address - Phone:916-509-8198
Practice Address - Fax:916-519-8199
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720540164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty