Healthcare Provider Details

I. General information

NPI: 1053642546
Provider Name (Legal Business Name): REBECCA R LEACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE INDIAN HILL RD
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366-2361
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4227
  • Fax: 760-572-4230
Mailing address:
  • Phone: 760-572-4227
  • Fax: 760-572-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008029950
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: