Provider Demographics
NPI:1588659197
Name:QUILANG, LEONARDO C (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:C
Last Name:QUILANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2661 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1412
Mailing Address - Country:US
Mailing Address - Phone:626-798-8792
Mailing Address - Fax:626-798-9607
Practice Address - Street 1:6601 RUGBY AVE
Practice Address - Street 2:#300
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4040
Practice Address - Country:US
Practice Address - Phone:323-582-1177
Practice Address - Fax:323-589-2635
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA49716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18561Medicare UPIN