Healthcare Provider Details

I. General information

NPI: 1972275451
Provider Name (Legal Business Name): LEILANI PALAD-SALES MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22031 MAIN ST UNIT 4
CARSON CA
90745-2900
US

IV. Provider business mailing address

22031 MAIN ST UNIT 4
CARSON CA
90745-2900
US

V. Phone/Fax

Practice location:
  • Phone: 424-422-9116
  • Fax:
Mailing address:
  • Phone: 424-422-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: