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General NPI Number Information
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NPI Number | 1497641336
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Entity Type | Individual
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Provider Name | RAFAEL LEAHU
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Gender | Male
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2715 W NORTHERN AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85051-6641
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Country | US
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Telephone | 503-707-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 5260 W MELINDA LN
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City | GLENDALE
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State | AZ
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Zip | 85308-9304
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Country | US
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Telephone | 503-707-2637
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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