Healthcare Provider Details

I. General information

NPI: 1003175746
Provider Name (Legal Business Name): CIANNA LEATHERWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

85 PARK DR APT 15
BOSTON MA
02215-5221
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA130966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: