Basic Information
| Provider Information | |||||||||
| NPI: | 1013668862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7210 MURRAY DR | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952103339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093732800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7912 WEST LN STE 221 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952103159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096365000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2022 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 106384 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | 106384 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.