MEDICARE: CID ANTONIO LEANOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1003758178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CID ANTONIO LEANOS

Provider Business Mailing Address
First Line	:	224 S 3RD ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-2120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 S 3RD ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-2120
Country	:	US
Telephone Number	:	510-426-2673
Fax Number	:	510-426-2673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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