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NPI Code Detail

MEDICARE: LEAH MAHOOD

MEDICARE: LEAH MAHOOD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-16-26678CA

General Provider Information

NPI Number : 1447754775
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MAHOOD
Provider Business Mailing Address
First Line : 6220 LAKEVILLE HWY
Second Line :
City : PETALUMA
State : CA
Zip : 94954-9522
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2 PADRE PKWY STE 101
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-2114
Country : US
Telephone Number : 707-553-1784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2018
Last Update Date : 05/12/2021

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Directions to “ LEAH MAHOOD ” Practice Location

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