Provider Demographics
NPI:1821838889
Name:MUMTAZ, LEENA
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:MUMTAZ
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 1:18173 PIONEER BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3986
Mailing Address - Country:US
Mailing Address - Phone:562-403-0488
Mailing Address - Fax:
Practice Address - Street 1:18173 PIONEER BLVD STE I
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3986
Practice Address - Country:US
Practice Address - Phone:562-403-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator