Healthcare Provider Details

I. General information

NPI: 1851635833
Provider Name (Legal Business Name): LEILANI NAVAR L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 W HWY 12
BOULDER UT
84716
US

IV. Provider business mailing address

PO BOX 1497
BOULDER UT
84716-1497
US

V. Phone/Fax

Practice location:
  • Phone: 435-335-7700
  • Fax:
Mailing address:
  • Phone: 435-335-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number9582448-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: