Healthcare Provider Details

I. General information

NPI: 1033764196
Provider Name (Legal Business Name): LEANN AIBOSHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S BEAUDRY AVE
LOS ANGELES CA
90017-1466
US

IV. Provider business mailing address

5325 ETHELDO AVE
CULVER CITY CA
90230-6026
US

V. Phone/Fax

Practice location:
  • Phone: 213-241-6200
  • Fax:
Mailing address:
  • Phone: 310-347-9420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: