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NPI Code Detail

MEDICARE: JERRY F LEANDADO LVN

MEDICARE: JERRY F LEANDADO LVN
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
1261QA1903XAmbulatory Surgical Clinic/Center39-07CA

General Provider Information

NPI Number : 1477616910
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY F LEANDADO LVN
Provider Business Mailing Address
First Line : 6868 BROOK FALLS CIR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-2445
Country : US
Telephone Number : 209-956-5754
Fax Number :
Provider Business Practice Location Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ JERRY F LEANDADO LVN” Practice Location

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