Healthcare Provider Details

I. General information

NPI: 1780891994
Provider Name (Legal Business Name): LEOPOLDO CANON VALENCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 77TH ST
SACRAMENTO CA
95820-3627
US

IV. Provider business mailing address

4228 77TH ST
SACRAMENTO CA
95820-3627
US

V. Phone/Fax

Practice location:
  • Phone: 916-457-2260
  • Fax: 916-457-2260
Mailing address:
  • Phone: 916-457-2260
  • Fax: 916-457-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: