Healthcare Provider Details

I. General information

NPI: 1386566149
Provider Name (Legal Business Name): THE HEALTHY L.E.O. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5165 RACCOON WAY
FONTANA CA
92336-0410
US

IV. Provider business mailing address

5165 RACCOON WAY
FONTANA CA
92336-0410
US

V. Phone/Fax

Practice location:
  • Phone: 909-714-7017
  • Fax:
Mailing address:
  • Phone: 909-714-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON CETINA
Title or Position: PRESIDENT
Credential:
Phone: 909-714-7017