1174684708 NPI number — MRS. ELIZABETH T LEONG R.D.

Table of content: MRS. ELIZABETH T LEONG R.D. (NPI 1174684708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174684708 NPI number — MRS. ELIZABETH T LEONG R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONG
Provider First Name:
ELIZABETH
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TSAI
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
AN-LI
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174684708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 RICHARDSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94949-6170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-506-0138
Provider Business Mailing Address Fax Number:
415-506-0187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1904 FRANKLIN ST STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94612-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-922-8208
Provider Business Practice Location Address Fax Number:
510-550-7966
Provider Enumeration Date:
12/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  354976 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)