Healthcare Provider Details

I. General information

NPI: 1477202828
Provider Name (Legal Business Name): LEONARDO RIGOBERTO SANTOS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S CENTRAL AVELOS ANGELES, CA 90013
LOS ANGELES CA
90013-1629
US

IV. Provider business mailing address

470 E 3RD ST STE A&B
LOS ANGELES CA
90013-1629
US

V. Phone/Fax

Practice location:
  • Phone: 213-372-5233
  • Fax:
Mailing address:
  • Phone: 213-626-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: