Provider Demographics
NPI:1649885732
Name:MORANCIE, LEANNE EVALYN
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:EVALYN
Last Name:MORANCIE
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 1:4231 BALBOA AVE # 1245
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:340-201-1949
Mailing Address - Fax:858-483-1918
Practice Address - Street 1:4231 BALBOA AVE # 1245
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5504
Practice Address - Country:US
Practice Address - Phone:340-201-1949
Practice Address - Fax:858-483-1918
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty