Individual
LESSA ILEANA ACOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30500 ARRASTRE CANYON RD., ACTON, CA 93510
(661) 223-8751
(661) 269-0427
Mailing address
30500 ARRASTRE CANYON RD, ACTON, CA 93510-2160
(661) 223-8751
(661) 269-0427
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
190001AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316397938
ANTELOPE VALLEY REHABILITATION CENTERS RESIDENTIAL
CA
Enumeration date
11/29/2018
Last updated
11/29/2018
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