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General NPI Number Information
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NPI Number | 1174684708
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Entity Type | Individual
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Provider Name | ELIZABETH T LEONG R.D.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 1904 FRANKLIN ST STE 801
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City | OAKLAND
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State | CA
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Zip | 94612-2915
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Country | US
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Telephone | 510-922-8208
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Fax | 510-550-7966
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Provider Business Mailing Address
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Address Line | 62 RICHARDSON RD
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City | NOVATO
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State | CA
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Zip | 94949-6170
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Country | US
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Telephone | 415-506-0138
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Fax | 415-506-0187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 354976
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License Number State | CA
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