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General NPI Number Information
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NPI Number | 1760863765
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Entity Type | Individual
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Provider Name | LEAH STURDEVANT
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Gender | Female
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 2605 CARLSBAD BLVD
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City | CARLSBAD
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State | CA
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Zip | 92008-2208
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Country | US
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Telephone | 760-729-2385
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Fax |
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Provider Business Mailing Address
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Address Line | 11243 PASEO MONTANOSO APT. 99
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City | SAN DIEGO
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State | CA
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Zip | 92127-5970
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Country | US
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Telephone | 858-361-1767
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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