Provider Demographics
NPI:1932873643
Name:MELCHOR LEON, JAILENE
Entity Type:Individual
Prefix:
First Name:JAILENE
Middle Name:
Last Name:MELCHOR LEON
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 1:4448 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-3328
Mailing Address - Country:US
Mailing Address - Phone:323-344-5233
Mailing Address - Fax:323-344-5237
Practice Address - Street 1:4448 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-3328
Practice Address - Country:US
Practice Address - Phone:323-344-5233
Practice Address - Fax:323-344-5237
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator