=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518502905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNADETTE LEONCIO DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2019
-----------------------------------------------------
Last Update Date | 11/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16315 WHITTIER BLVD SUITE 105
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90603-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-315-5054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16315 WHITTIER BLVD STE 105
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90603-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-315-5054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. GLADYS GOMEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-315-5054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------