Healthcare Provider Details

I. General information

NPI: 1891611844
Provider Name (Legal Business Name): LEONARDO LEON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13939 E 14TH ST STE 170
SAN LEANDRO CA
94578-2601
US

IV. Provider business mailing address

1615 104TH AVE
OAKLAND CA
94603-3232
US

V. Phone/Fax

Practice location:
  • Phone: 510-220-9578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: