Healthcare Provider Details

I. General information

NPI: 1023496379
Provider Name (Legal Business Name): STEVEN LEONARD II SUDCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE B
MODESTO CA
95350-5814
US

IV. Provider business mailing address

1904 RICHALND AVE
CERES CA
95307
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-7412
  • Fax:
Mailing address:
  • Phone: 209-541-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberAII8911214
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberAII7891214
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: