Provider Demographics
NPI:1396953758
Name:HERMOSURA-BAUTISTA, LEILANI (RN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:LEILANI
Middle Name:
Last Name:HERMOSURA-BAUTISTA
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:LEILANI
Other - Middle Name:
Other - Last Name:HERMOSURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, NP-C
Mailing Address - Street 1:19433 AMHURST CT
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6787
Mailing Address - Country:US
Mailing Address - Phone:562-401-6843
Mailing Address - Fax:562-401-6047
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-401-8291
Practice Address - Fax:562-401-6047
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily