Healthcare Provider Details

I. General information

NPI: 1669758264
Provider Name (Legal Business Name): GABRIELLE ADISA LEEGANT MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 INTERNATIONAL BOULEVARD
OAKLAND CA
94606-2235
US

IV. Provider business mailing address

225 INTERNATIONAL BLOUVARD
OAKLAND CA
94606-2235
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-2777
  • Fax:
Mailing address:
  • Phone: 510-835-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: