Healthcare Provider Details

I. General information

NPI: 1871280875
Provider Name (Legal Business Name): LEONARD ARNEL PASCUA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD UNIT B
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1783 CHELAN RD
WEST SACRAMENTO CA
95691-4935
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6666
  • Fax: 415-473-4113
Mailing address:
  • Phone: 707-699-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number705715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: