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General NPI Number Information
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NPI Number | 1295542918
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Entity Type | Individual
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Provider Name | LEA JOAQUIN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 2407 MADDEN TER
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City | SAN JOSE
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State | CA
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Zip | 95116-1948
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Country | US
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Telephone | 310-408-5751
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 ENBORG LN
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City | SAN JOSE
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State | CA
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Zip | 95128-2648
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Country | US
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Telephone | 408-885-5487
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 247738
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License Number State | CA
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