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NPI Code Detail

MEDICARE: DAMON TANNER LEACH

MEDICARE: DAMON TANNER LEACH
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
1172V00000XCommunity Health Worker
2390200000XStudent in an Organized Health Care Education/Training Program
3104100000XSocial Worker137997CA

General Provider Information

NPI Number : 1043093859
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMON TANNER LEACH
Provider Business Mailing Address
First Line : 8421 AUBURN BLVD STE 3
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-0391
Country : US
Telephone Number : 208-881-3811
Fax Number :
Provider Business Practice Location Address
First Line : 8421 AUBURN BLVD STE 3
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-0391
Country : US
Telephone Number : 916-344-0199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2023
Last Update Date : 06/08/2026

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Directions to “ DAMON TANNER LEACH ” Practice Location

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