Healthcare Provider Details

I. General information

NPI: 1497488571
Provider Name (Legal Business Name): LEIANA-RICHELLE CHEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 VISTA WAY STE 100
OCEANSIDE CA
92056-3694
US

IV. Provider business mailing address

3156 VISTA WAY STE 100
OCEANSIDE CA
92056-3694
US

V. Phone/Fax

Practice location:
  • Phone: 760-681-5222
  • Fax:
Mailing address:
  • Phone: 760-681-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: