Healthcare Provider Details

I. General information

NPI: 1588785919
Provider Name (Legal Business Name): LEIGH DEYARMOND RABIDEAUX CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 508
ORANGE CA
92868-3856
US

IV. Provider business mailing address

10532 SEMORA ST
BELLFLOWER CA
90706-7142
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax: 844-387-7625
Mailing address:
  • Phone: 562-900-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number468068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: