Provider Demographics
NPI:1801502349
Name:AGSAO, LEAH PAULA (RN)
Entity type:Individual
Prefix:
First Name:LEAH PAULA
Middle Name:
Last Name:AGSAO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEAH PAULA
Other - Middle Name:
Other - Last Name:DITANGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:H. CLAUDE HUDSON COMPREHENSIVE HEALTH CARE CENTER
Mailing Address - Street 2:2829 S GRAND AVE
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007
Mailing Address - Country:US
Mailing Address - Phone:213-699-7180
Mailing Address - Fax:
Practice Address - Street 1:H. CLAUDE HUDSON COMPREHENSIVE HEALTH CARE CENTER
Practice Address - Street 2:2829 S GRAND AVE
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-9000
Practice Address - Country:US
Practice Address - Phone:213-699-7180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179438163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse