Healthcare Provider Details

I. General information

NPI: 1023832888
Provider Name (Legal Business Name): DEBORA LUNA LEVERETT ACC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD
GLENDALE CA
91203-2308
US

IV. Provider business mailing address

2509 RANCHLAND WAY
ROSEVILLE CA
95747-8087
US

V. Phone/Fax

Practice location:
  • Phone: 916-742-0999
  • Fax:
Mailing address:
  • Phone: 916-742-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: