Individual
LEONORA B BANTUGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 565C, LOS ANGELES, CA 90095-1252
(310) 267-2555
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
(310) 301-8707
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95019337
CA
363LP2300X
Primary Care Nurse Practitioner
95019337
CA
Other
Enumeration date
12/08/2021
Last updated
08/01/2024
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