Healthcare Provider Details

I. General information

NPI: 1982203592
Provider Name (Legal Business Name): LEAHANN VEDELLA PSYCHIATRIC TECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 06/06/2022
Certification Date: 05/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 CLAREMONT AVE
OAKLAND CA
94618-1032
US

IV. Provider business mailing address

5275 CLAREMONT AVE
OAKLAND CA
94618-1032
US

V. Phone/Fax

Practice location:
  • Phone: 511-428-3000
  • Fax:
Mailing address:
  • Phone: 511-428-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: