Provider Demographics
NPI:1760973036
Name:LEON, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 PAINTER AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3546
Mailing Address - Country:US
Mailing Address - Phone:562-762-0900
Mailing Address - Fax:
Practice Address - Street 1:8930 PAINTER AVE APT 122
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3546
Practice Address - Country:US
Practice Address - Phone:562-762-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst