Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95015990 | CA |
NPI | 1174178933 |
---|---|
Provider Name | Michael James Leininger JR. |
First Address | Oakland, CA 94610-5113 |
Second Address | San Francisco, CA 94110-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2019 |
Last Update Date | 19/11/2020 |