Healthcare Provider Details

I. General information

NPI: 1073120556
Provider Name (Legal Business Name): REZIA PEARL LEOPANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ESSEX ST
SAN FRANCISCO CA
94105-3195
US

IV. Provider business mailing address

25 ESSEX ST
SAN FRANCISCO CA
94105-3195
US

V. Phone/Fax

Practice location:
  • Phone: 154-767-3412
  • Fax: 415-977-0168
Mailing address:
  • Phone: 154-767-3412
  • Fax: 415-977-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: