Provider Demographics
NPI:1790242014
Name:LEON, SARAI (RN)
Entity Type:Individual
Prefix:
First Name:SARAI
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 POMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1716
Mailing Address - Country:US
Mailing Address - Phone:323-728-0411
Mailing Address - Fax:
Practice Address - Street 1:1900 E SLAUSON AVE STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2725
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:323-277-9158
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95329323163WC0400X
CA685054164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No164X00000XNursing Service ProvidersLicensed Vocational Nurse