Healthcare Provider Details

I. General information

NPI: 1255219721
Provider Name (Legal Business Name): LEO ROSAS SAFFARI WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEO ROSAS VICKERS

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 N WILSON WAY # G
STOCKTON CA
95205-4272
US

IV. Provider business mailing address

2362 AMERICAN RIVER DR APT 109
SACRAMENTO CA
95825-7034
US

V. Phone/Fax

Practice location:
  • Phone: 209-466-2081
  • Fax:
Mailing address:
  • Phone: 916-342-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95036823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: