Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC16463 | CA |
NPI | 1598786295 |
---|---|
Provider Name | Dr. Cynthia C Leeder |
First Address | Carlsbad, CA 92008 |
Second Address | Carlsbad, CA 92008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0164630 | BLUE SHIELD OF CA (01) | CA |
T18340 | (02) | CA |