=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972460319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA SELINA LEAL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2161 W 6TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-483-8222
-----------------------------------------------------
Fax | 213-413-0457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2161 W 6TH ST
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-483-8222
-----------------------------------------------------
Fax | 213-413-0457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 111968
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------