Healthcare Provider Details

I. General information

NPI: 1578050985
Provider Name (Legal Business Name): LEAH SITLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 KERNER BLVD
SAN RAFAEL CA
94901-5411
US

IV. Provider business mailing address

3110 KERNER BLVD
SAN RAFAEL CA
94901-5411
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax:
Mailing address:
  • Phone: 415-448-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA163784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: