Provider Demographics
NPI:1134640352
Name:RICHARD, LEON
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 KILSON DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-2954
Mailing Address - Country:US
Mailing Address - Phone:949-734-7432
Mailing Address - Fax:949-734-7433
Practice Address - Street 1:2201 KILSON DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-2954
Practice Address - Country:US
Practice Address - Phone:949-734-7432
Practice Address - Fax:949-734-7433
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1305340518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)