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NPI Code Detail

MEDICARE: JENSEN MARIE LEONARD

MEDICARE: JENSEN MARIE LEONARD
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1316447311
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENSEN MARIE LEONARD
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 18800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-4976
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 334 VIA VERA CRUZ STE 107
Second Line :
City : SAN MARCOS
State : CA
Zip : 92078-2637
Country : US
Telephone Number : 760-304-5010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2018
Last Update Date : 02/15/2018

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