Provider Demographics
NPI:1558758698
Name:RICHARD, LEAH KATHERINE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:KATHERINE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHERINE
Other - Last Name:BOHNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:969 DANA CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-3781
Mailing Address - Country:US
Mailing Address - Phone:415-517-6161
Mailing Address - Fax:
Practice Address - Street 1:1020 SERPENTINE LN
Practice Address - Street 2:SUITE 115
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4758
Practice Address - Country:US
Practice Address - Phone:415-517-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16455171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist