Provider Demographics
NPI:1881875854
Name:CARREON, LETICIA (HEALTH SERVICE ASST)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CARREON
Suffix:
Gender:F
Credentials:HEALTH SERVICE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47923 OASIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-9788
Mailing Address - Country:US
Mailing Address - Phone:760-863-8315
Mailing Address - Fax:760-863-8186
Practice Address - Street 1:47923 OASIS ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-9788
Practice Address - Country:US
Practice Address - Phone:760-863-8315
Practice Address - Fax:760-863-8186
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator