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General NPI Number Information
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NPI Number | 1477342376
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Entity Type | Individual
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Provider Name | YOSELIN DIANE DE LEON-LAZO
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 11643 GLENOAKS BLVD
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City | PACOIMA
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State | CA
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Zip | 91331-1099
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Country | US
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Telephone | 260-981-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4820
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Country | US
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Telephone | 310-751-5269
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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