Provider Demographics
NPI:1235904558
Name:LEONOV, DARIA
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:LEONOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARI
Other - Middle Name:
Other - Last Name:LEONOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1106 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0818
Mailing Address - Country:US
Mailing Address - Phone:916-680-4678
Mailing Address - Fax:
Practice Address - Street 1:1949 5TH ST STE 103
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4026
Practice Address - Country:US
Practice Address - Phone:530-753-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker