Healthcare Provider Details

I. General information

NPI: 1760188742
Provider Name (Legal Business Name): LEANNA DEANGELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL RD
SONORA CA
95370-5227
US

IV. Provider business mailing address

2 S. GREEN ST.
SONORA CA
95370-4618
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-6412
  • Fax:
Mailing address:
  • Phone: 209-223-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: