Healthcare Provider Details

I. General information

NPI: 1578596128
Provider Name (Legal Business Name): LEAHY PROSTHETICS & ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FREDERICK ST
SANTA CRUZ CA
95062-2203
US

IV. Provider business mailing address

630 FREDERICK ST
SANTA CRUZ CA
95062
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-5900
  • Fax: 831-425-0488
Mailing address:
  • Phone: 831-425-5900
  • Fax: 831-425-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP2178
License Number StateCA

VIII. Authorized Official

Name: KEVIN M LEAHY
Title or Position: CEO
Credential: CP
Phone: 831-425-5900