Healthcare Provider Details

I. General information

NPI: 1174465959
Provider Name (Legal Business Name): JUAN PABLO LEANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39139 10TH ST E
PALMDALE CA
93550-3419
US

IV. Provider business mailing address

39139 10TH ST E
PALMDALE CA
93550-3419
US

V. Phone/Fax

Practice location:
  • Phone: 661-789-6783
  • Fax:
Mailing address:
  • Phone: 661-789-6783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: