Provider Demographics
NPI:1720519150
Name:RAMADAN, LEILAS
Entity Type:Individual
Prefix:
First Name:LEILAS
Middle Name:
Last Name:RAMADAN
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 1:2775 SOUTH MAIN STREET
Mailing Address - Street 2:201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-279-3222
Mailing Address - Fax:951-279-5222
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE E1
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2740
Practice Address - Country:US
Practice Address - Phone:951-471-1426
Practice Address - Fax:951-471-1453
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY3247728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health