Provider Demographics
NPI:1689428658
Name:ZENTENO, LEANDER
Entity type:Individual
Prefix:
First Name:LEANDER
Middle Name:
Last Name:ZENTENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8445 S PUSH COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2316
Mailing Address - Country:US
Mailing Address - Phone:469-562-2786
Mailing Address - Fax:
Practice Address - Street 1:8445 S PUSH COUNTY RD
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2316
Practice Address - Country:US
Practice Address - Phone:469-562-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217418163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management