Healthcare Provider Details

I. General information

NPI: 1154742062
Provider Name (Legal Business Name): LEIGH-ANNE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4853
US

IV. Provider business mailing address

29177 GATEWAY DR
LAKE ELSINORE CA
92530-7287
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-9200
  • Fax:
Mailing address:
  • Phone: 949-521-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP16190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: