Provider Demographics
NPI:1881064939
Name:LEUTERIO, POL DIEL
Entity type:Individual
Prefix:
First Name:POL
Middle Name:DIEL
Last Name:LEUTERIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 SOUTH ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6618
Mailing Address - Country:US
Mailing Address - Phone:424-731-7455
Mailing Address - Fax:424-214-1189
Practice Address - Street 1:11618 SOUTH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-6618
Practice Address - Country:US
Practice Address - Phone:424-731-7455
Practice Address - Fax:424-214-1189
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15647225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15647OtherOCCUPATIONAL THERAPY LICENSE