Healthcare Provider Details

I. General information

NPI: 1689353369
Provider Name (Legal Business Name): LEILA ACTUB QUINTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEILA SERRANO ACTUB RN

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

10623 SNOW LAKE ST
LAS VEGAS NV
89179-1418
US

V. Phone/Fax

Practice location:
  • Phone: 626-375-5548
  • Fax:
Mailing address:
  • Phone: 626-375-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number454343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: