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General NPI Number Information
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NPI Number | 1235020793
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Entity Type | Individual
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Provider Name | LEANDRO SEVILLA MOCTEZUMA
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 3443 LILLY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-3091
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Country | US
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Telephone | 877-910-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 128 WOODVIEW LN
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City | WINLOCK
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State | WA
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Zip | 98596-9706
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Country | US
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Telephone | 360-353-6628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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