Healthcare Provider Details

I. General information

NPI: 1891022117
Provider Name (Legal Business Name): EMILY S LEO RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLLARD RD STE. B205
LOS GATOS CA
95032-1415
US

IV. Provider business mailing address

800 POLLARD RD STE. B205
LOS GATOS CA
95032-1415
US

V. Phone/Fax

Practice location:
  • Phone: 408-370-0330
  • Fax: 408-871-1210
Mailing address:
  • Phone: 408-370-0330
  • Fax: 408-871-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number153880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number153880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: