Healthcare Provider Details

I. General information

NPI: 1093233363
Provider Name (Legal Business Name): JULIE LEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344-6367
US

IV. Provider business mailing address

10605 BALBOA BLVD STE 100
GRANADA HILLS CA
91344-6367
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-2400
  • Fax:
Mailing address:
  • Phone: 818-824-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: