Healthcare Provider Details

I. General information

NPI: 1902008550
Provider Name (Legal Business Name): ERIC G LEACH-RODRIGUEZ DE ARRIBA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 7TH AVE RM 1205
NEW YORK NY
10001-5411
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-7560
  • Fax: 212-627-7563
Mailing address:
  • Phone: 323-860-5200
  • Fax: 323-467-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: