Healthcare Provider Details

I. General information

NPI: 1003745696
Provider Name (Legal Business Name): LEEZA LEILANI MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEZA LEILANI PHILSON RN

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FUNSTON AVE
PRESIDIO CA
94129-1109
US

IV. Provider business mailing address

4 FUNSTON AVE
PRESIDIO CA
94129-1109
US

V. Phone/Fax

Practice location:
  • Phone: 415-339-2692
  • Fax:
Mailing address:
  • Phone: 415-339-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95276677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: