MEDICARE: FOFOGA LEA'EA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1326347287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOFOGA LEA'EA

Provider Business Mailing Address
First Line	:	19300 RINALDI ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1651
Country	:	US
Telephone Number	:	562-343-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	19300 RINALDI ST
Second Line	:	# 8270
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1651
Country	:	US
Telephone Number	:	562-343-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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Directions to “ FOFOGA LEA'EA ” Practice Location

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