Provider Demographics
NPI:1912698499
Name:DIXON, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DIXON
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 1:631 S BROOKHURST ST # 104
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3510
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:714-620-8132
Practice Address - Street 1:631 S BROOKHURST ST # 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3510
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:714-620-8132
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA733069164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse