Provider Demographics
NPI:1386020220
Name:LEIMBERG, NOVELLA (LAC)
Entity Type:Individual
Prefix:MS
First Name:NOVELLA
Middle Name:
Last Name:LEIMBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5529
Mailing Address - Country:US
Mailing Address - Phone:530-965-3512
Mailing Address - Fax:
Practice Address - Street 1:526 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4431
Practice Address - Country:US
Practice Address - Phone:530-965-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist