Healthcare Provider Details

I. General information

NPI: 1356906424
Provider Name (Legal Business Name): STEVEN ALEXANDER LEUSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 05/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CONNECTICUT ST
SAN FRANCISCO CA
94107-2451
US

IV. Provider business mailing address

13651 CUNNINGHAM DR
CARMEL IN
46074-2308
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95011526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: