Healthcare Provider Details

I. General information

NPI: 1275160020
Provider Name (Legal Business Name): RYAN ROBERT LEACHMAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E MAIN ST SUITE 201
SANTA MARIA CA
93454
US

IV. Provider business mailing address

1430 E MAIN ST SUITE 201
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-3548
  • Fax: 805-925-4545
Mailing address:
  • Phone: 805-922-3548
  • Fax: 805-925-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A21267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: