Provider Demographics
NPI:1508540261
Name:AGUAYO, LEZLIE MIRAYA
Entity Type:Individual
Prefix:
First Name:LEZLIE
Middle Name:MIRAYA
Last Name:AGUAYO
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 1:11439 FLORENCE AVE
Mailing Address - Street 2:APT. 13
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:323-330-5409
Mailing Address - Fax:
Practice Address - Street 1:8300 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3493
Practice Address - Country:US
Practice Address - Phone:323-330-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker