Provider Demographics
NPI:1780012047
Name:VALLES, LEONIDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONIDA
Middle Name:
Last Name:VALLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1600
Mailing Address - Country:US
Mailing Address - Phone:626-917-1267
Mailing Address - Fax:626-918-9647
Practice Address - Street 1:1365 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1600
Practice Address - Country:US
Practice Address - Phone:626-917-1267
Practice Address - Fax:626-918-9647
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist