Healthcare Provider Details

I. General information

NPI: 1043481096
Provider Name (Legal Business Name): LEILA ANDRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 S FAIRVIEW ST UNIT H
SANTA ANA CA
92704-5953
US

IV. Provider business mailing address

2805 S FAIRVIEW ST UNIT H
SANTA ANA CA
92704-5953
US

V. Phone/Fax

Practice location:
  • Phone: 949-338-2251
  • Fax:
Mailing address:
  • Phone: 949-338-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: