Healthcare Provider Details

I. General information

NPI: 1205790631
Provider Name (Legal Business Name): ANTHONY LEONARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 UNIVERSITY AVE
BERKELEY CA
94704-1023
US

IV. Provider business mailing address

1919 ADDISON ST STE 204
BERKELEY CA
94704-1143
US

V. Phone/Fax

Practice location:
  • Phone: 510-809-3004
  • Fax: 510-809-3240
Mailing address:
  • Phone: 510-809-3004
  • Fax: 510-809-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: