Provider Demographics
NPI:1891032520
Name:GONZALES, LEILA CABRERA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:CABRERA
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10558 HOLLINGSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2870
Mailing Address - Country:US
Mailing Address - Phone:858-382-2549
Mailing Address - Fax:858-312-6631
Practice Address - Street 1:400 CRAVEN ROAD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078
Practice Address - Country:US
Practice Address - Phone:858-382-2549
Practice Address - Fax:858-312-6631
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY44860Medicaid