Healthcare Provider Details

I. General information

NPI: 1720013576
Provider Name (Legal Business Name): WARREN LEO CIPA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CASA BUENA DR
CORTE MADERA CA
94925-1709
US

IV. Provider business mailing address

101 CASA BUENA DR.
CORTE MADERA CA
94925
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-4525
  • Fax:
Mailing address:
  • Phone: 415-924-4525
  • Fax: 415-924-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number20068
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: