Healthcare Provider Details

I. General information

NPI: 1710807011
Provider Name (Legal Business Name): LEOBARDO ROSAS BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEACH DR
SALINAS CA
93901-3710
US

IV. Provider business mailing address

11 PEACH DR
SALINAS CA
93901-3710
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5138
  • Fax:
Mailing address:
  • Phone: 831-753-5138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberTBA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: