Provider Demographics
NPI:1851626923
Name:VICEDO, LELALEE C
Entity Type:Individual
Prefix:
First Name:LELALEE
Middle Name:C
Last Name:VICEDO
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 1:8021 S VERMONT AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3563
Mailing Address - Country:US
Mailing Address - Phone:323-445-9093
Mailing Address - Fax:
Practice Address - Street 1:8021 S VERMONT AVE APT 23
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3563
Practice Address - Country:US
Practice Address - Phone:323-445-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health