MEDICARE: LEAH HODGE

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	225400000X	Rehabilitation Practitioner
2	101YM0800X	Mental Health Counselor		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FHC11833F	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1396904900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH HODGE

Provider Business Mailing Address
First Line	:	1333 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5212
Country	:	US
Telephone Number	:	408-445-3400
Fax Number	:	408-269-1952

Provider Business Practice Location Address
First Line	:	1118 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4350
Country	:	US
Telephone Number	:	408-445-3400
Fax Number	:	408-998-8043

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/11/2025

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Directions to “ LEAH HODGE ” Practice Location

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