Healthcare Provider Details

I. General information

NPI: 1184209181
Provider Name (Legal Business Name): LEAH MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TUOLUMNE ST
VALLEJO CA
94590-5700
US

IV. Provider business mailing address

355 TUOLUMNE ST # 2500
VALLEJO CA
94590-5700
US

V. Phone/Fax

Practice location:
  • Phone: 707-553-5331
  • Fax:
Mailing address:
  • Phone: 707-553-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: