Provider Demographics
NPI:1073925640
Name:YAHIRO LEIBOWITZ, ALANA SUZANNE
Entity Type:Individual
Prefix:
First Name:ALANA SUZANNE
Middle Name:
Last Name:YAHIRO LEIBOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAMPICO STE 210
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2962
Mailing Address - Country:US
Mailing Address - Phone:925-935-6952
Mailing Address - Fax:925-935-1396
Practice Address - Street 1:110 TAMPICO STE 210
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2962
Practice Address - Country:US
Practice Address - Phone:925-935-6952
Practice Address - Fax:925-935-1396
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17250261QA0006X
CAPA17250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility