Healthcare Provider Details

I. General information

NPI: 1467883652
Provider Name (Legal Business Name): LEILANI ANDRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEILANI PAIAINA

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 02/10/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 SE 192ND AVE # 101
VANCOUVER WA
98683-1471
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 360-605-1881
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax: 360-573-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: