Healthcare Provider Details

I. General information

NPI: 1174684708
Provider Name (Legal Business Name): ELIZABETH T LEONG R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ELIZABETH AN-LI TSAI

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 FRANKLIN ST STE 801
OAKLAND CA
94612-2915
US

IV. Provider business mailing address

62 RICHARDSON RD
NOVATO CA
94949-6170
US

V. Phone/Fax

Practice location:
  • Phone: 510-922-8208
  • Fax: 510-550-7966
Mailing address:
  • Phone: 415-506-0138
  • Fax: 415-506-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number354976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: