Healthcare Provider Details

I. General information

NPI: 1144158072
Provider Name (Legal Business Name): ELIZABETH DISANTI LEOPARD PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA LEOPARD

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 OLD COUNTY RD
TEMPLETON CA
93465-5062
US

IV. Provider business mailing address

1936 LA PURISMA CT
SAN MIGUEL CA
93451-9087
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5872
  • Fax:
Mailing address:
  • Phone: 805-712-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210129184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: