Individual
ANTARA LEONID DE BOURBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
400 RED HAWK LN, APTOS, CA 95003-2668
(831) 588-8871
Mailing address
400 RED HAWK LN, APTOS, CA 95003-2668
(831) 588-8871
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
764892
CA
Other
Enumeration date
10/14/2011
Last updated
10/14/2011
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