Provider Demographics
NPI:1801603154
Name:ABASTTA, LEONORA CRUZ
Entity type:Individual
Prefix:
First Name:LEONORA
Middle Name:CRUZ
Last Name:ABASTTA
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 1:3475 REBECCA LN APT C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5138
Mailing Address - Country:US
Mailing Address - Phone:719-306-4403
Mailing Address - Fax:
Practice Address - Street 1:3475 REBECCA LN APT C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5138
Practice Address - Country:US
Practice Address - Phone:719-306-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter