Healthcare Provider Details

I. General information

NPI: 1548392251
Provider Name (Legal Business Name): LEIGH ROBERTA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CIVIC CT STE 1350
CONCORD CA
94520-5279
US

IV. Provider business mailing address

1485 CIVIC CT STE 1350
CONCORD CA
94520-5279
US

V. Phone/Fax

Practice location:
  • Phone: 925-212-4933
  • Fax:
Mailing address:
  • Phone: 925-212-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51033
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: