Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | L3138 | CA |
NPI | 1083204754 |
---|---|
Provider Name | Mrs. Ruth Beham Leonard |
First Address | Concord, CA 94518-2628 |
Second Address | San Francisco, CA 94102-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2021 |
Last Update Date | 26/01/2021 |