Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 26396 | CA |
NPI | 1053688440 |
---|---|
Provider Name | Janell C Leanillo |
First Address | Hawthorne, CA 90250-5806 |
Second Address | Hawthorne, CA 90250-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 25/06/2012 |