Basic Information
| Provider Information | |||||||||
| NPI: | 1447740469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IGUALDO | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | BEHAVIOR TECHINICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11037 WARNER AVE # 339 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927084007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148488319 | ||||||||
| FaxNumber: | 7145966274 | ||||||||
| Practice Location | |||||||||
| Address1: | 2535 CAMINO DEL RIO S STE 155 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002734292 | ||||||||
| FaxNumber: | 8882933374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2018 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.