Healthcare Provider Details

I. General information

NPI: 1649576901
Provider Name (Legal Business Name): LEON SAMUEL OLIVER BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

IV. Provider business mailing address

4353 E COLFAX AVE
DENVER CO
80220-1115
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax: 303-758-5793
Mailing address:
  • Phone: 303-504-1048
  • Fax: 303-320-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: