Provider Demographics
NPI:1013688845
Name:SANATI, LEILA LEONARDO VALE
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:LEONARDO VALE
Last Name:SANATI
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 1:26W107 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2955
Mailing Address - Country:US
Mailing Address - Phone:949-880-6093
Mailing Address - Fax:
Practice Address - Street 1:26W107 JEROME AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2955
Practice Address - Country:US
Practice Address - Phone:949-880-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILWM5HP-4SHS174400000X
ILWKCEJ-22MT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist