Healthcare Provider Details

I. General information

NPI: 1376407155
Provider Name (Legal Business Name): LEAH THERESE O'NEAL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR # 1600
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

PO BOX 1533
CEDAR CITY UT
84721-1515
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-4150
  • Fax:
Mailing address:
  • Phone: 760-995-6814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number14203746-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: