Healthcare Provider Details

I. General information

NPI: 1619816840
Provider Name (Legal Business Name): KAMRON LEONARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 W 14TH ST
UPLAND CA
91786-2517
US

IV. Provider business mailing address

2750 VIA SEVILLE
FULLERTON CA
92835-2831
US

V. Phone/Fax

Practice location:
  • Phone: 760-887-3180
  • Fax: 909-303-3314
Mailing address:
  • Phone: 951-496-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: