Healthcare Provider Details

I. General information

NPI: 1235510710
Provider Name (Legal Business Name): JENNIFER LEONIAK D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DELBON AVE
TURLOCK CA
95382-2019
US

IV. Provider business mailing address

PO BOX 4978
MODESTO CA
95352-4978
US

V. Phone/Fax

Practice location:
  • Phone: 209-208-0923
  • Fax: 209-748-4850
Mailing address:
  • Phone: 209-575-4575
  • Fax: 209-575-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number13410
License Number StateCA

VIII. Authorized Official

Name: JAMIE DOLE
Title or Position: MANGER
Credential:
Phone: 209-575-4575