Healthcare Provider Details

I. General information

NPI: 1801419585
Provider Name (Legal Business Name): EVA MARIA GLENN LECEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26600 CACTUS AVE STE 300
MORENO VALLEY CA
92555-3901
US

IV. Provider business mailing address

26600 CACTUS AVE STE 300
MORENO VALLEY CA
92555-3901
US

V. Phone/Fax

Practice location:
  • Phone: 951-988-9500
  • Fax: 951-571-8936
Mailing address:
  • Phone: 951-988-9500
  • Fax: 951-571-8936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA186111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: