Provider Demographics
NPI:1306414016
Name:LEAFWING
Entity Type:Organization
Organization Name:LEAFWING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SHIGEO
Authorized Official - Last Name:TANIGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-561-6576
Mailing Address - Street 1:2127 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1954
Mailing Address - Country:US
Mailing Address - Phone:714-710-3040
Mailing Address - Fax:
Practice Address - Street 1:2127 W ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-1954
Practice Address - Country:US
Practice Address - Phone:714-710-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty