Healthcare Provider Details

I. General information

NPI: 1528221223
Provider Name (Legal Business Name): LEEANN MARIE CUNY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE STE 120
SANTA ROSA CA
95401-7153
US

IV. Provider business mailing address

1260 N DUTTON AVE STE 120
SANTA ROSA CA
95401-7153
US

V. Phone/Fax

Practice location:
  • Phone: 707-656-3453
  • Fax: 855-225-6308
Mailing address:
  • Phone: 707-656-3453
  • Fax: 855-225-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A12304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: