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General NPI Number Information
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NPI Number | 1467954644
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Entity Type | Individual
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Provider Name | BIANCA MARIE LEUNG PA-C, MS, RD
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 11/20/2021
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Provider Practice Location Address
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Address Line | 7425 E SHEA BLVD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-6411
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Country | US
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Telephone | 480-285-2180
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Fax |
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Provider Business Mailing Address
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Address Line | 15407 S 184TH DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-3650
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Country | US
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Telephone | 915-540-3136
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8639
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86026218
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License Number State | AZ
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