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General NPI Number Information
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NPI Number | 1003477878
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Entity Type | Organization
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Legal Business Name | LL INTEGRATIVE LIFE
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 112 LA CASA VIA STE 175
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3055
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Country | US
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Telephone | 925-522-9885
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 COCO LN
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City | WALNUT CREEK
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State | CA
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Zip | 94598-1841
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Country | US
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Telephone | 916-595-5577
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LILLIAN W. LEONG
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Credential | DO
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Telephone | 916-595-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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