Provider Demographics
NPI:1144347428
Name:NILLAS, LEONISA PANGILINAN (RN, PHN)
Entity type:Individual
Prefix:
First Name:LEONISA
Middle Name:PANGILINAN
Last Name:NILLAS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:LEONISA
Other - Middle Name:SANTOS
Other - Last Name:PANGILINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 MARIPOSA CIR
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2787
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 OXFORD ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7111
Practice Address - Country:US
Practice Address - Phone:619-336-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA525509163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health