Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | C38900 | CA |
NPI | 1477692382 |
---|---|
Provider Name | Dr. Crisanto O Leonor |
First Address | Riverside, CA 92503-9551 |
Second Address | Rialto, CA 92376-5230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |