Healthcare Provider Details

I. General information

NPI: 1740245034
Provider Name (Legal Business Name): STEVEN J LEIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 HIGHWAY 9
FELTON CA
95018-9713
US

IV. Provider business mailing address

9500 CENTRAL AVE
BEN LOMOND CA
95005-9349
US

V. Phone/Fax

Practice location:
  • Phone: 831-335-9141
  • Fax: 831-335-1341
Mailing address:
  • Phone: 831-336-3200
  • Fax: 831-336-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00G416080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: