Healthcare Provider Details

I. General information

NPI: 1467954644
Provider Name (Legal Business Name): BIANCA MARIE LEUNG PA-C, MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 11/20/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7425 E SHEA BLVD STE 100
SCOTTSDALE AZ
85260-6411
US

IV. Provider business mailing address

15407 S 184TH DR
GOODYEAR AZ
85338-3650
US

V. Phone/Fax

Practice location:
  • Phone: 480-285-2180
  • Fax:
Mailing address:
  • Phone: 915-540-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8639
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86026218
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: