Healthcare Provider Details

I. General information

NPI: 1497828362
Provider Name (Legal Business Name): IMELDA MORALES LEABRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BRODERICK ST
SAN FRANCISCO CA
94115-3304
US

IV. Provider business mailing address

2010 VALLEJO ST
SAN FRANCISCO CA
94123-4868
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-1760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN200355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: