Basic Information
| Provider Information | |||||||||
| NPI: | 1497133805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARREDONDO | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | L.V.N. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARREDONDO | ||||||||
| OtherFirstName: | LEONARD | ||||||||
| OtherMiddleName: | ANTHONY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | L.V.N. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 N CENTRAL AVE | ||||||||
| Address2: | 250 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912033905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185398359 | ||||||||
| FaxNumber: | 8552458903 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 N CENTRAL AVE | ||||||||
| Address2: | 250 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912033905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185398359 | ||||||||
| FaxNumber: | 8552458903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 251726 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.