Healthcare Provider Details

I. General information

NPI: 1679357065
Provider Name (Legal Business Name): LEAH TAYLOR PETERSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

558 FAIRHILLS DR
SAN RAFAEL CA
94901-1115
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-4000
  • Fax:
Mailing address:
  • Phone: 415-328-6819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: