Healthcare Provider Details

I. General information

NPI: 1477284982
Provider Name (Legal Business Name): MS. LEILANI KISA ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15513 S TARRANT AVE
COMPTON CA
90220-3226
US

IV. Provider business mailing address

15513 S TARRANT AVE
COMPTON CA
90220-3226
US

V. Phone/Fax

Practice location:
  • Phone: 909-609-1415
  • Fax:
Mailing address:
  • Phone: 909-609-1415
  • Fax: 805-910-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: