Provider Demographics
NPI:1558620021
Name:LEGASPI, LEONARDO ASUTILLA (NP)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:ASUTILLA
Last Name:LEGASPI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 EL PORTAL CT
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5204
Mailing Address - Country:US
Mailing Address - Phone:323-821-9700
Mailing Address - Fax:
Practice Address - Street 1:3710 EAST CESAR CHAVEZ AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2219
Practice Address - Country:US
Practice Address - Phone:323-980-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily