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NPI Code Detail

MEDICARE: JESUS LEIJA

MEDICARE: JESUS LEIJA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1205334893
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESUS LEIJA
Provider Business Mailing Address
First Line : 5326 E BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-2104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5326 E BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90022-2104
Country : US
Telephone Number : 866-590-6411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2018
Last Update Date : 01/29/2018

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Directions to “ JESUS LEIJA ” Practice Location

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