Healthcare Provider Details

I. General information

NPI: 1013679927
Provider Name (Legal Business Name): LEONARDO NARESH JUAREZ DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 MIDDLEFIELD RD STE 102
PALO ALTO CA
94306-2567
US

IV. Provider business mailing address

617 BAYONET CIR
MARINA CA
93933-4600
US

V. Phone/Fax

Practice location:
  • Phone: 650-798-6330
  • Fax:
Mailing address:
  • Phone: 831-384-7251
  • Fax: 831-384-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: