Provider Demographics
NPI:1609156454
Name:BALLEZA, LEANNA (CD(DONA))
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:BALLEZA
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SW 185TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6645
Mailing Address - Country:US
Mailing Address - Phone:208-283-0933
Mailing Address - Fax:
Practice Address - Street 1:919 SW 185TH AVE
Practice Address - Street 2:APARTMENT 2
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-6669
Practice Address - Country:US
Practice Address - Phone:208-283-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula