Provider Demographics
NPI:1013673680
Name:LEYNES, CAROL L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:LEYNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18825 GRAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5834
Mailing Address - Country:US
Mailing Address - Phone:714-747-2580
Mailing Address - Fax:
Practice Address - Street 1:1313 W 8TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4422
Practice Address - Country:US
Practice Address - Phone:213-401-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant