Provider Demographics
NPI:1417420597
Name:RELEAF INSTITUTE INC
Entity Type:Organization
Organization Name:RELEAF INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-618-8428
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 1170
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2122
Mailing Address - Country:US
Mailing Address - Phone:310-828-0002
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 1170
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2122
Practice Address - Country:US
Practice Address - Phone:310-828-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center