Provider Demographics
NPI:1245799345
Name:KALIDIS, LEONARDO NIKOLAS
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:NIKOLAS
Last Name:KALIDIS
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 1:879 W 190TH ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4255
Mailing Address - Country:US
Mailing Address - Phone:310-329-9115
Mailing Address - Fax:
Practice Address - Street 1:879 W 190TH ST STE 1000
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4255
Practice Address - Country:US
Practice Address - Phone:310-329-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician