Provider Demographics
NPI:1659490399
Name:CALDWELL, LEIGH ELLEN (LAC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ELLEN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 YORBA STREET, SUITE 105
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3358
Mailing Address - Country:US
Mailing Address - Phone:714-742-6821
Mailing Address - Fax:949-786-1663
Practice Address - Street 1:14101 YORBA STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2041
Practice Address - Country:US
Practice Address - Phone:714-742-6821
Practice Address - Fax:949-786-1663
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist