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1679045546
LEANDRO MODENESE BASTOS
LAKE ELSINORE, CA
NPI
1679045546
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: CA 296037)
Enumeration Date
2018-12-17
Last Update Date
2019-07-25
Business Address
LEANDRO MODENESE BASTOS PT DPT
425 DIAMOND DR STE 101
LAKE ELSINORE, CA 92530-4495
Phone number: 951-674-9515
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Mailing Address
LEANDRO MODENESE BASTOS PT DPT
1060 VALE TERRACE DR APT 8
VISTA, CA 92084-5228
Phone number: 562-212-8477
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