Provider Demographics
NPI:1538296611
Name:LEROY, AMANDA (BA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LEROY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4448
Mailing Address - Country:US
Mailing Address - Phone:626-676-2010
Mailing Address - Fax:
Practice Address - Street 1:1433 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3414
Practice Address - Country:US
Practice Address - Phone:310-785-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program