Provider Demographics
NPI:1245981208
Name:CHIU, LEZZLIE ANNE ANGBENGCO
Entity type:Individual
Prefix:MRS
First Name:LEZZLIE ANNE
Middle Name:ANGBENGCO
Last Name:CHIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEZZLIE ANNE
Other - Middle Name:GERODIAS
Other - Last Name:ANGBENGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 S BANNA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3554
Mailing Address - Country:US
Mailing Address - Phone:626-400-8059
Mailing Address - Fax:
Practice Address - Street 1:433 S BANNA AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3554
Practice Address - Country:US
Practice Address - Phone:626-400-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily