Provider Demographics
NPI:1255138889
Name:LEANO, JACQUELINE ELISE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELISE
Last Name:LEANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26781 BRIDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7574
Mailing Address - Country:US
Mailing Address - Phone:949-306-0417
Mailing Address - Fax:
Practice Address - Street 1:26781 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7574
Practice Address - Country:US
Practice Address - Phone:949-306-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst