Healthcare Provider Details

I. General information

NPI: 1821639311
Provider Name (Legal Business Name): LEONIE BARBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

IV. Provider business mailing address

9920 PACIFIC HEIGHTS BLVD SUITE 150
SAN DIEGO CA
92121-4396
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119922
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: