Healthcare Provider Details

I. General information

NPI: 1427106905
Provider Name (Legal Business Name): JACOB KYLE LEONE ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 NOVATO BLVD SUITE 100
NOVATO CA
94947
US

IV. Provider business mailing address

448 IGNACIO BLVD # 294
NOVATO CA
94949-6085
US

V. Phone/Fax

Practice location:
  • Phone: 415-484-1240
  • Fax: 866-484-0518
Mailing address:
  • Phone: 415-484-1240
  • Fax: 866-484-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: