MEDICARE: MRS. PATRICIA ANNE MARIE LEONARD R.D.

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	133V00000X	Registered Dietitian	994928	CA

General Provider Information

NPI Number	:	1538341813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANNE MARIE LEONARD R.D.

Provider Business Mailing Address
First Line	:	PO BOX 1914
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93448-1914
Country	:	US
Telephone Number	:	805-904-9782
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 EFFIE WAY
Second Line	:	HOME
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3259
Country	:	US
Telephone Number	:	805-904-9782
Fax Number	:

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	11/29/2007

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